Provider Demographics
NPI:1528644994
Name:RISLOVE, ELLEN (OTR/L)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:RISLOVE
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 1:35 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03290-6100
Mailing Address - Country:US
Mailing Address - Phone:207-370-1744
Mailing Address - Fax:833-227-0462
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NH
Practice Address - Zip Code:03044-3427
Practice Address - Country:US
Practice Address - Phone:603-767-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3118OtherLICENSE