Provider Demographics
NPI:1750420402
Name:FREIRE-DAVIS, ELISA KAY (OTR)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:KAY
Last Name:FREIRE-DAVIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PENNY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3423
Mailing Address - Country:US
Mailing Address - Phone:631-673-0930
Mailing Address - Fax:
Practice Address - Street 1:44 PENNY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3423
Practice Address - Country:US
Practice Address - Phone:631-673-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005600-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor