Healthcare Provider Details

I. General information

NPI: 1053454942
Provider Name (Legal Business Name): EILEEN ELIZABETH PAUST M.S., O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2178 SW MAINSAIL TER
STUART FL
34997-4846
US

IV. Provider business mailing address

2178 SW MAINSAIL TER
STUART FL
34997-4846
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-7464
  • Fax: 772-221-7464
Mailing address:
  • Phone: 772-221-7464
  • Fax: 772-221-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 11463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: