Provider Demographics
NPI:1184186512
Name:HOWE, ELISSA LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:LEIGH
Last Name:HOWE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 MAYFAIR LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7508
Mailing Address - Country:US
Mailing Address - Phone:386-795-1614
Mailing Address - Fax:
Practice Address - Street 1:60 N HIGHWAY 17 92
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2513
Practice Address - Country:US
Practice Address - Phone:386-668-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19583225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist