Provider Demographics
NPI:1720584493
Name:STANISLAV, ELISE NICOLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:NICOLE
Last Name:STANISLAV
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 1:2130 HIDEAWAY CT
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2900
Mailing Address - Country:US
Mailing Address - Phone:443-812-8288
Mailing Address - Fax:
Practice Address - Street 1:2130 HIDEAWAY CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2900
Practice Address - Country:US
Practice Address - Phone:443-812-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist