Healthcare Provider Details

I. General information

NPI: 1386281947
Provider Name (Legal Business Name): ELISABETH NERHUS MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12545 ORANGE DR STE 502
DAVIE FL
33330-4306
US

IV. Provider business mailing address

1919 SE 10TH AVE APT 1109
FORT LAUDERDALE FL
33316-2993
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-8048
  • Fax:
Mailing address:
  • Phone: 952-913-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: