MEDICARE: MS. ELLERI WYATT LEBLANC MSOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT10618	FL
2	225XP0200X	Pediatric Occupational Therapist	OT18517	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003998808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLERI WYATT LEBLANC MSOTR/L

Provider Business Mailing Address
First Line	:	1935 STATE ROAD 436 STE 1005
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2244
Country	:	US
Telephone Number	:	407-629-9455
Fax Number	:	407-629-9138

Provider Business Practice Location Address
First Line	:	1935 STATE ROAD 436 STE 1005
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2244
Country	:	US
Telephone Number	:	407-629-9455
Fax Number	:	407-629-9138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/14/2019

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Directions to “ MS. ELLERI WYATT LEBLANC MSOTR/L” Practice Location

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