Healthcare Provider Details

I. General information

NPI: 1003729872
Provider Name (Legal Business Name): ELYSSA HULSE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7498 N SHORE DR
ERIE PA
16511-1616
US

IV. Provider business mailing address

7498 N SHORE DR
ERIE PA
16511-1616
US

V. Phone/Fax

Practice location:
  • Phone: 814-923-1308
  • Fax:
Mailing address:
  • Phone: 814-923-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC020689
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: