Elisa Dali Fuentes, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

7679 Issued in SC

Practice address

1563 Sam Rittenberg Blvd
Charleston, SC 29407-4248

Phone

(843) 277-2411

Fax

(855) 504-4089

NPI assigned

Jul 24, 2023

Last updated

Sep 12, 2025By 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

Enrolled in SC

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Charleston St LLC

  • Speech-Language Pathologist
  • Charleston, SC
  • NPI 1629777511
  NPD

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

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1871273979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4033 HARTLAND ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294146095",
            "telephone_number": "404-661-7784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1563 SAM RITTENBERG BLVD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294074248",
            "telephone_number": "843-277-2411",
            "fax_number": "855-504-4089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "ELISA",
        "middle_name": "DALI",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-24",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "SC",
            "license": "7679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Duane Naldo Froes, AGACNP
• Jeffrey Innes Frohock, M.D.
• Torrey Fry
• Vanessa Grace Fry
• Michael D Frye, MD
• Toby Lynn Fugate, D.O.
• Robert Blake Fugatt Jr., M.D.
• Kelsey Renee Full, DO
• Anna Katherine Fuller
• Carolyn G Fuller, OT

• Occupational Therapist in Charleston, SC
• Providers in Charleston, SC by specialty
• Occupational Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.