Provider Demographics
NPI:1194960716
Name:PESTO, ELISA MILLER (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:MILLER
Last Name:PESTO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 CORNSTALK LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-3259
Mailing Address - Country:US
Mailing Address - Phone:334-740-1438
Mailing Address - Fax:
Practice Address - Street 1:2450 VILLAGE PROFESSIONAL DR N
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4734
Practice Address - Country:US
Practice Address - Phone:334-740-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist