Provider Demographics
NPI:1336023068
Name:CASTILLO, ELIZANETTE (OTD,OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZANETTE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:OTD,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 NC 55 HWY APT 1304
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2076
Mailing Address - Country:US
Mailing Address - Phone:860-629-9603
Mailing Address - Fax:860-629-9603
Practice Address - Street 1:300 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2681
Practice Address - Country:US
Practice Address - Phone:919-361-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17833225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology