Individual
ELISE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
9009 WHITE ROCK TRL, DALLAS, TX 75238-3347
(214) 355-3300
Mailing address
3501 ROSS AVE APT 1011, DALLAS, TX 75204-5450
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214604
TX
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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