Healthcare Provider Details

I. General information

NPI: 1528644994
Provider Name (Legal Business Name): ELLEN RISLOVE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MAIN ST
FREMONT NH
03044-3427
US

IV. Provider business mailing address

35 GARLAND RD
NOTTINGHAM NH
03290-6100
US

V. Phone/Fax

Practice location:
  • Phone: 603-767-3137
  • Fax:
Mailing address:
  • Phone: 207-370-1744
  • Fax: 833-227-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3118
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: