Provider Demographics
NPI:1821220393
Name:PARKS, ELSA RUIZ (O,TR)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:RUIZ
Last Name:PARKS
Suffix:
Gender:F
Credentials:O,TR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N COLLINS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3564
Mailing Address - Country:US
Mailing Address - Phone:469-385-7292
Mailing Address - Fax:469-385-4265
Practice Address - Street 1:1701 N COLLINS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3564
Practice Address - Country:US
Practice Address - Phone:469-385-7292
Practice Address - Fax:469-385-4265
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107085225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics