Provider Demographics
NPI:1811172695
Name:ELAFROS, MARTHA M (OTR)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:ELAFROS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 LITTLE STATION RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2617
Mailing Address - Country:US
Mailing Address - Phone:616-460-0684
Mailing Address - Fax:
Practice Address - Street 1:236 LITTLE STATION RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2617
Practice Address - Country:US
Practice Address - Phone:616-460-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001255225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist