Elissa Katherine Dzambasow, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

09906 Issued in MD

Practice address

1750 E Fairmount Ave
Baltimore, MD 21231-1534

Phone

(443) 923-3870

NPI assigned

Mar 6, 2023

Last updated

Mar 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678060800000",
    "number": "1558061820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 BYNUM VIEW CT",
            "city": "ABINGDON",
            "state": "MD",
            "postal_code": "210093024",
            "telephone_number": "443-567-0998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E FAIRMOUNT AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311534",
            "telephone_number": "443-923-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZAMBASOW",
        "first_name": "ELISSA",
        "middle_name": "KATHERINE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "09906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Occupational Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.