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General NPI Number Information
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NPI Number | 1811318629
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Entity Type | Individual
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Provider Name | ELISHIA DODGE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/20/2013
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Last Update Date | 12/20/2013
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Provider Practice Location Address
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Address Line | 12124 HIGH TECH AVE SUITE 300 ATTN: JACKSON THERAPY PARTNERS
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City | ORLANDO
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State | FL
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Zip | 32817-8373
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Country | US
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Telephone | 800-774-7785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 244
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City | DANFORTH
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State | ME
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Zip | 04424-0244
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Country | US
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Telephone | 207-538-6000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 11102
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License Number State | MA
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