Provider Demographics
NPI:1720511744
Name:OLIVA, ELSA (OTR/L)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:OLIVA
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 1:1618 S BROAD ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-1509
Mailing Address - Country:US
Mailing Address - Phone:845-325-2209
Mailing Address - Fax:
Practice Address - Street 1:924 CHERRY ST # 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2411
Practice Address - Country:US
Practice Address - Phone:267-909-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014344225X00000X
NJ46TR00761800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist