Provider Demographics
NPI:1609008895
Name:ARNOLD, ELISSA O (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:O
Last Name:ARNOLD
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 1:1361 S WALNUT ST
Mailing Address - Street 2:UNIT 3825
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2274
Mailing Address - Country:US
Mailing Address - Phone:714-928-1281
Mailing Address - Fax:
Practice Address - Street 1:1361 S WALNUT ST
Practice Address - Street 2:UNIT 3825
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2274
Practice Address - Country:US
Practice Address - Phone:714-928-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9684225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235316OtherNBCOT
CA9684OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY