Provider Demographics
NPI:1760951792
Name:BASILETTI, ELISE HOPE (DSP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:HOPE
Last Name:BASILETTI
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MULBERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-3934
Mailing Address - Country:US
Mailing Address - Phone:765-409-1829
Mailing Address - Fax:
Practice Address - Street 1:2 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3021
Practice Address - Country:US
Practice Address - Phone:317-232-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist