Provider Demographics
NPI:1033475504
Name:STOUT, ELIZABETH ANN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:STOUT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:JORGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:10552 BASTILLE LN
Mailing Address - Street 2:APT. 205
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-4622
Mailing Address - Country:US
Mailing Address - Phone:321-441-5721
Mailing Address - Fax:407-778-1142
Practice Address - Street 1:10552 BASTILLE LN
Practice Address - Street 2:APT. 205
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-4622
Practice Address - Country:US
Practice Address - Phone:321-441-5721
Practice Address - Fax:407-778-1142
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 11332224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant