Provider Demographics
NPI:1952075418
Name:DRISCOLL, ELIZABETH AUDREY (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AUDREY
Last Name:DRISCOLL
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 1:1255 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-1710
Mailing Address - Country:US
Mailing Address - Phone:617-909-8874
Mailing Address - Fax:
Practice Address - Street 1:7525 METROPOLITAN DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4411
Practice Address - Country:US
Practice Address - Phone:619-692-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT22374225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics