Healthcare Provider Details

I. General information

NPI: 1114914454
Provider Name (Legal Business Name): ELIZABETH BLAKE CURTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 KINGSLEY AVE SUITE 6B
ORANGE PARK FL
32073-4537
US

IV. Provider business mailing address

1409 KINGSLEY AVE SUITE 6B
ORANGE PARK FL
32073-4537
US

V. Phone/Fax

Practice location:
  • Phone: 904-215-2422
  • Fax: 904-215-6122
Mailing address:
  • Phone: 904-215-2422
  • Fax: 904-215-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT0001647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: