MEDICARE: ELIZABETH MCCLOSKEY

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	OT9835	FL

General Provider Information

NPI Number	:	1871632968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MCCLOSKEY

Provider Business Mailing Address
First Line	:	941 SE CANDLE AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-4003
Country	:	US
Telephone Number	:	772-871-5711
Fax Number	:	772-871-5711

Provider Business Practice Location Address
First Line	:	941 SE CANDLE AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-4003
Country	:	US
Telephone Number	:	772-871-5711
Fax Number	:	772-871-5711

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/09/2007

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