Provider Demographics
NPI:1952963589
Name:CASEY, ELISSA RAE (OTR, ATP)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:RAE
Last Name:CASEY
Suffix:
Gender:F
Credentials:OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14557 W INDIAN SCHOOL RD # 500
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-242-6908
Mailing Address - Fax:623-242-6909
Practice Address - Street 1:14557 W INDIAN SCHOOL RD # 500
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-242-6908
Practice Address - Fax:623-242-6909
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-008145225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist