Provider Demographics
NPI:1518324003
Name:ELFAND, TRACY (COTA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ELFAND
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 SWANSON DR
Mailing Address - Street 2:SUITE 100/200
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5859
Mailing Address - Country:US
Mailing Address - Phone:407-977-4448
Mailing Address - Fax:407-977-4402
Practice Address - Street 1:1486 SWANSON DR
Practice Address - Street 2:SUITE 100/200
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5859
Practice Address - Country:US
Practice Address - Phone:407-977-4448
Practice Address - Fax:407-977-4402
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13904224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA13904OtherSTATE OF FLORIDA