Provider Demographics
NPI:1760980643
Name:WOO, ELISA (MS)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:WOO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 GEORGIA AVE NW APT 501
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5961
Mailing Address - Country:US
Mailing Address - Phone:973-248-7839
Mailing Address - Fax:
Practice Address - Street 1:4827 RUGBY AVE STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3028
Practice Address - Country:US
Practice Address - Phone:301-657-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010001398225X00000X
MD08310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist