Provider Demographics
NPI:1760196422
Name:GIFFORD, ELISABETH (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GLENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-6705
Mailing Address - Country:US
Mailing Address - Phone:732-675-2765
Mailing Address - Fax:
Practice Address - Street 1:17 WATCHUNG PLZ
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4117
Practice Address - Country:US
Practice Address - Phone:862-621-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist