Individual
ELIZABETH COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
1000 EDDY ST, PROVIDENCE, RI 02905-4739
(401) 602-9640
(401) 533-9105
Mailing address
1000 EDDY ST, PROVIDENCE, RI 02905-4739
(401) 602-9640
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT02208
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0614
NHPRI
RI
05
—
ES01788
—
RI
01
—
SB870
BC RI
RI
Enumeration date
08/02/2023
Last updated
09/06/2024
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