Provider Demographics
NPI:1053102061
Name:ELISE MARIE OT
Entity type:Organization
Organization Name:ELISE MARIE OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT
Authorized Official - Phone:920-585-0698
Mailing Address - Street 1:552 MEADOW WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-8491
Mailing Address - Country:US
Mailing Address - Phone:920-585-0698
Mailing Address - Fax:
Practice Address - Street 1:552 MEADOW WOOD CIR
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-8491
Practice Address - Country:US
Practice Address - Phone:920-585-0698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty