Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 11463 | FL |
NPI | 1053454942 |
---|---|
Provider Name | Mrs. Eileen Elizabeth Paust |
First Address | Stuart, FL 34997-4846 |
Second Address | Stuart, FL 34997-4846 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8917574 00 | (05) | FL |