MEDICARE: REMICK ELISE SPENCER 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	OT17217	FL

General Provider Information

NPI Number	:	1417625534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REMICK ELISE SPENCER OTR/L

Provider Business Mailing Address
First Line	:	4500 SAN PABLO RD S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-1865
Country	:	US
Telephone Number	:	904-953-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2757 S 300 W STE F
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-2956
Country	:	US
Telephone Number	:	864-659-3180
Fax Number	:

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

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	11/25/2024

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