Provider Demographics
NPI:1578006110
Name:ESGRO, MARY ELISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELISE
Last Name:ESGRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1775
Mailing Address - Country:US
Mailing Address - Phone:570-677-7197
Mailing Address - Fax:
Practice Address - Street 1:802 MONROE ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1707
Practice Address - Country:US
Practice Address - Phone:570-460-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist