MEDICARE: MRS. CAMERAN ELISE MCWILLIAMS

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	225X00000X	Occupational Therapist	OT17548	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	:	1447649611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMERAN ELISE MCWILLIAMS

Provider Business Mailing Address
First Line	:	660 SPANISH WELLS RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8926
Country	:	US
Telephone Number	:	904-502-8502
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 GILMORE ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3211
Country	:	US
Telephone Number	:	904-906-3878
Fax Number	:

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

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	05/05/2025

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