Healthcare Provider Details

I. General information

NPI: 1639122948
Provider Name (Legal Business Name): ELISSA MICHELE FIORITO OTR/L, CLT-LANA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WALL ST SUITE 100
WEST LONG BRANCH NJ
07764-1181
US

IV. Provider business mailing address

305 PROVINCIAL DR
MORGANVILLE NJ
07751-4163
US

V. Phone/Fax

Practice location:
  • Phone: 732-222-8556
  • Fax: 732-222-8663
Mailing address:
  • Phone: 732-591-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00074700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: