Healthcare Provider Details

I. General information

NPI: 1417476474
Provider Name (Legal Business Name): ELLIOT STARCEVICH OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 S BALTIC PL
MERIDIAN ID
83642-5935
US

IV. Provider business mailing address

651 S WALNUT AVE # D226
NEW BRAUNFELS TX
78130-5722
US

V. Phone/Fax

Practice location:
  • Phone: 208-898-0988
  • Fax:
Mailing address:
  • Phone: 15125769884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1608
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: