Active NPI
Elise Favreau
- Occupational Therapist
- Manchester, NH
National Provider Identifier
1144369703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1849
- Practice address
- 555 Auburn St
Manchester, NH 03103-4803 - Phone
- (603) 623-8863
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1849 | NH | Primary |
Addresses
Primary practice location
555 Auburn St
Manchester, NH 03103-4803
Mailing address
38 S Hall St
Manchester, NH 03103-4639
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13Y010632NH01 | Other | NH | ANTHEM |
| 389989 | Other | NH | MVP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1849 | NH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144369703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 S HALL ST",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031034639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 AUBURN ST",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031034803",
"telephone_number": "603-623-8863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAVREAU",
"first_name": "ELISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NH",
"license": "1849",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "13Y010632NH01",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "389989",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.