Provider Demographics
NPI:1295483634
Name:LAU, ELAINE LEE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:LEE
Last Name:LAU
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 1:524 E MAUDE AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4475
Mailing Address - Country:US
Mailing Address - Phone:415-816-4522
Mailing Address - Fax:
Practice Address - Street 1:373 PINE LN
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1694
Practice Address - Country:US
Practice Address - Phone:650-948-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455396225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist