Basic Information
| Provider Information | |||||||||
| NPI: | 1447675236 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYALA-CASTELLANOS | ||||||||
| FirstName: | ELIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 476 W DIVISION RD | ||||||||
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| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463859014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198010834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 S CALUMET RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463043285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199839675 | ||||||||
| FaxNumber: | 2199839681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2014 | ||||||||
| LastUpdateDate: | 03/03/2014 | ||||||||
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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 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.