=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457503542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISA H TOLKOV OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2008
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 ROUTE 6
-----------------------------------------------------
City | MAHOPAC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10541-4746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-804-4220
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 ARBOR CRST
-----------------------------------------------------
City | SOMERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10589-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-485-1079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 009525
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------