Provider Demographics
NPI:1306543061
Name:EHLIS, ADELAIDE (OTR/L)
Entity type:Individual
Prefix:
First Name:ADELAIDE
Middle Name:
Last Name:EHLIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4131
Mailing Address - Country:US
Mailing Address - Phone:973-619-2925
Mailing Address - Fax:
Practice Address - Street 1:5 ROOSEVELT AVE STE A
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2572
Practice Address - Country:US
Practice Address - Phone:973-507-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01105800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist