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General NPI Number Information
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NPI Number | 1881889004
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Entity Type | Individual
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Provider Name | MICHELLE ELAINE TEIXEIRA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 2245 PLANTATION CENTER DR BLDG. 9, SUITE 59
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City | ORANGE PARK
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State | FL
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Zip | 32003-3352
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Country | US
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Telephone | 904-215-9046
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Fax | 904-215-9317
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Provider Business Mailing Address
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Address Line | 1668 INKBERRY LN
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City | JACKSONVILLE
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State | FL
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Zip | 32259-5449
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Country | US
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Telephone |
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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 | OT3055
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License Number State | FL
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