Provider Demographics
NPI:1235465782
Name:FINKLE, ELIZABETH REGINA (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:REGINA
Last Name:FINKLE
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 1:889 SW GRAND RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2346
Mailing Address - Country:US
Mailing Address - Phone:772-336-1301
Mailing Address - Fax:772-336-3190
Practice Address - Street 1:889 SW GRAND RESERVE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2346
Practice Address - Country:US
Practice Address - Phone:772-336-1301
Practice Address - Fax:772-336-3190
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist