Provider Demographics
NPI:1548038839
Name:PRESTA, ELENA (OTR/L)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:PRESTA
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 1:445 N ARDMORE AVE APT P
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-1704
Mailing Address - Country:US
Mailing Address - Phone:630-363-8431
Mailing Address - Fax:
Practice Address - Street 1:1371 ABBOTT CT
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2367
Practice Address - Country:US
Practice Address - Phone:847-777-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056015816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist