Provider Demographics
NPI:1255609723
Name:ELZA, ASHLEY DANIELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DANIELLE
Last Name:ELZA
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 1:6000 HAMPTON CTR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1748
Mailing Address - Country:US
Mailing Address - Phone:304-599-9250
Mailing Address - Fax:304-599-5040
Practice Address - Street 1:6000 HAMPTON CTR
Practice Address - Street 2:SUITE B
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1748
Practice Address - Country:US
Practice Address - Phone:304-599-9250
Practice Address - Fax:304-599-5040
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1565OtherBOARD OF OCCUPATIONAL THERAPY