Healthcare Provider Details

I. General information

NPI: 1194215459
Provider Name (Legal Business Name): ELISA WERN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2018
Last Update Date: 05/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6032 NW 31ST TER
GAINESVILLE FL
32653-1735
US

IV. Provider business mailing address

6032 NW 31ST TER
GAINESVILLE FL
32653-1735
US

V. Phone/Fax

Practice location:
  • Phone: 352-327-8388
  • Fax:
Mailing address:
  • Phone: 352-327-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT10448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: