Basic Information
| Provider Information | |||||||||
| NPI: | 1063994572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELIDRISSI | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | LEILA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 VAN BRACKLE RD | ||||||||
| Address2: | |||||||||
| City: | MATAWAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077471812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322846876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 ROUTE 73 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080439573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568093500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2018 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.