Provider Demographics
NPI:1043573629
Name:NIRLEN, ELIN BEATRICE OLIVIA (OTR)
Entity Type:Individual
Prefix:MISS
First Name:ELIN
Middle Name:BEATRICE OLIVIA
Last Name:NIRLEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SOUTH HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-9800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTH HOSPITAL DRIVE
Practice Address - Street 2:GENESIS SHOAL CREEK REHABILIATION CENTER
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-9800
Practice Address - Country:US
Practice Address - Phone:186-674-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT14938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist