MEDICARE: ELAINE C TESLOVICH OTR/L

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	OT18047	FL

General Provider Information

NPI Number	:	1205885654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE C TESLOVICH OTR/L

Provider Business Mailing Address
First Line	:	1200 LEXINGTON GREEN LN
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1013
Country	:	US
Telephone Number	:	407-322-3442
Fax Number	:	407-322-8404

Provider Business Practice Location Address
First Line	:	617 CANAL ST STE B&C
Second Line	:
City	:	NEW SMYRNA
State	:	FL
Zip	:	32168-6901
Country	:	US
Telephone Number	:	386-410-6903
Fax Number	:	386-402-7459

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	12/13/2019

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