Provider Demographics
NPI:1548861289
Name:LEVY, ELYSA I (OTL)
Entity type:Individual
Prefix:MRS
First Name:ELYSA
Middle Name:I
Last Name:LEVY
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2142
Mailing Address - Country:US
Mailing Address - Phone:201-218-8772
Mailing Address - Fax:
Practice Address - Street 1:51 LOCUST LN
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2142
Practice Address - Country:US
Practice Address - Phone:201-218-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00484500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist