Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT21974 | FL |
NPI | 1023769650 |
---|---|
Provider Name | Elaina Carr |
First Address | Crestview, FL 32536-1706 |
Second Address | Crestview, FL 32536-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2022 |
Last Update Date | 14/01/2022 |