Provider Demographics
NPI:1366273831
Name:EPPLEY, ELISSA (COTA/L)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:EPPLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 BAUMGARDNER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH FORK
Mailing Address - State:PA
Mailing Address - Zip Code:15956-3408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 WOODMONT RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1342
Practice Address - Country:US
Practice Address - Phone:814-255-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant