Provider Demographics
NPI:1114914454
Name:CURTIS, ELIZABETH BLAKE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BLAKE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 KINGSLEY AVE
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4537
Mailing Address - Country:US
Mailing Address - Phone:904-215-2422
Mailing Address - Fax:904-215-6122
Practice Address - Street 1:1409 KINGSLEY AVE
Practice Address - Street 2:SUITE 6B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4537
Practice Address - Country:US
Practice Address - Phone:904-215-2422
Practice Address - Fax:904-215-6122
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0001647225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4453BMedicare ID - Type Unspecified