Healthcare Provider Details

I. General information

NPI: 1154233328
Provider Name (Legal Business Name): ELISSA PAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42015 N VENTURE DR
PHOENIX AZ
85086-3193
US

IV. Provider business mailing address

3866 W CALLE LEJOS
GLENDALE AZ
85310-4151
US

V. Phone/Fax

Practice location:
  • Phone: 888-654-1948
  • Fax: 800-880-4022
Mailing address:
  • Phone: 602-315-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-010508
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: