Provider Demographics
NPI:1417476474
Name:STARCEVICH, ELLIOT (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:STARCEVICH
Suffix:
Gender:M
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 1:651 S WALNUT AVE # D226
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5722
Mailing Address - Country:US
Mailing Address - Phone:1512-576-9884
Mailing Address - Fax:
Practice Address - Street 1:68 S BALTIC PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5935
Practice Address - Country:US
Practice Address - Phone:208-898-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1608225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics