Basic Information
| Provider Information | |||||||||
| NPI: | 1255609723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELZA | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 HAMPTON CTR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265051748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045999250 | ||||||||
| FaxNumber: | 3045995040 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 HAMPTON CTR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265051748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045999250 | ||||||||
| FaxNumber: | 3045995040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2011 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1565 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1565 | 01 | WV | BOARD OF OCCUPATIONAL THERAPY | OTHER |