Provider Demographics
NPI:1033414677
Name:BLACKBURN, ELIZABETH CHAPMAN (OT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CHAPMAN
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LARA
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1337 S INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 1321
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1402
Mailing Address - Country:US
Mailing Address - Phone:407-833-0802
Mailing Address - Fax:
Practice Address - Street 1:1337 S INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 1321
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1402
Practice Address - Country:US
Practice Address - Phone:407-833-0802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTT14453225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist