Provider Demographics
NPI:1962933275
Name:ELISA SEIDNER OTR INC.
Entity type:Organization
Organization Name:ELISA SEIDNER OTR INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:310-922-1029
Mailing Address - Street 1:2814 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2410
Mailing Address - Country:US
Mailing Address - Phone:310-444-8812
Mailing Address - Fax:310-444-8813
Practice Address - Street 1:2814 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2410
Practice Address - Country:US
Practice Address - Phone:310-444-8812
Practice Address - Fax:310-444-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty