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General NPI Number Information
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NPI Number | 1457435455
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Entity Type | Individual
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Provider Name | EDITH SELDEN EZELL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4 JACKSON ST NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4925
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Country | US
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Telephone | 850-862-7227
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Fax |
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Provider Business Mailing Address
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Address Line | 501 BLACKWATER RUN
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City | NICEVILLE
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State | FL
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Zip | 32578-1642
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Country | US
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Telephone | 850-678-6400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 9614
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License Number State | FL
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