Provider Demographics
NPI:1457933848
Name:EISENBUD, ELIZABETH NICOLE (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:EISENBUD
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7917
Mailing Address - Country:US
Mailing Address - Phone:508-309-8770
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 350G
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6136
Practice Address - Country:US
Practice Address - Phone:978-712-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-25
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist