Healthcare Provider Details

I. General information

NPI: 1972407666
Provider Name (Legal Business Name): ELENI KAUTTU OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 CAROLWOOD LN
ST AUGUSTINE FL
32086-4320
US

IV. Provider business mailing address

400 SHORES BLVD NULL
ST AUGUSTINE FL
32086-7348
US

V. Phone/Fax

Practice location:
  • Phone: 904-315-8525
  • Fax:
Mailing address:
  • Phone: 904-315-8525
  • Fax: 904-212-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: