MEDICARE: ELISE DAUCHOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1366021008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE DAUCHOT

Provider Business Mailing Address
First Line	:	305 2ND ST
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-4662
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 2ND ST
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-4662
Country	:	US
Telephone Number	:	310-991-7892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2021
Last Update Date	:	04/07/2021

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Directions to “ ELISE DAUCHOT ” Practice Location

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