MEDICARE: ELISE SAXTON OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT0003136	FL

General Provider Information

NPI Number	:	1144869868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE SAXTON OT

Provider Business Mailing Address
First Line	:	348 SPARROW WOOD CT
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5921
Country	:	US
Telephone Number	:	772-646-1365
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 SPARROW WOOD CT
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5921
Country	:	US
Telephone Number	:	772-646-1365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2019
Last Update Date	:	12/28/2019

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