Healthcare Provider Details

I. General information

NPI: 1740110568
Provider Name (Legal Business Name): ELIZABETH WELCH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WASHINGTON ST
NEW SMYRNA BEACH FL
32168-7068
US

IV. Provider business mailing address

115 WASHINGTON ST
NEW SMYRNA BEACH FL
32168-7068
US

V. Phone/Fax

Practice location:
  • Phone: 904-717-7782
  • Fax:
Mailing address:
  • Phone: 904-717-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: