Healthcare Provider Details

I. General information

NPI: 1922501287
Provider Name (Legal Business Name): ELISA JOY DRY MA, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2954 RODEO PARK DR W
SANTA FE NM
87505-6351
US

IV. Provider business mailing address

369 MONTEZUMA AVE # 371
SANTA FE NM
87501-2835
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-8394
  • Fax:
Mailing address:
  • Phone: 505-400-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3878
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: