Provider Demographics
NPI:1629373329
Name:GARCIA, ELISA (ELISA GARCIA, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ELISA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:ELISA GARCIA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GROVE ACRE AVE
Mailing Address - Street 2:329
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2365
Mailing Address - Country:US
Mailing Address - Phone:831-920-2217
Mailing Address - Fax:
Practice Address - Street 1:230 GROVE ACRE AVE
Practice Address - Street 2:329
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2365
Practice Address - Country:US
Practice Address - Phone:831-920-2217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4290225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics