Healthcare Provider Details

I. General information

NPI: 1568881860
Provider Name (Legal Business Name): LAUREN MARIE ELITZAK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 AVENIDA DEL ORO
OCEANSIDE CA
92056-5829
US

IV. Provider business mailing address

1361 W 9TH AVE APT 604
ESCONDIDO CA
92029-2209
US

V. Phone/Fax

Practice location:
  • Phone: 760-945-6500
  • Fax:
Mailing address:
  • Phone: 978-490-5907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14249
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: