Provider Demographics
NPI:1053454942
Name:PAUST, EILEEN ELIZABETH (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:ELIZABETH
Last Name:PAUST
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 SW MAINSAIL TER
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-4846
Mailing Address - Country:US
Mailing Address - Phone:772-221-7464
Mailing Address - Fax:772-221-7464
Practice Address - Street 1:2178 SW MAINSAIL TER
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4846
Practice Address - Country:US
Practice Address - Phone:772-221-7464
Practice Address - Fax:772-221-7464
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11463225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8917574 00Medicaid