Provider Demographics
NPI:1598733115
Name:MCGARVA, ELISE B (OTR L)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:B
Last Name:MCGARVA
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 1:1609 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6644
Mailing Address - Country:US
Mailing Address - Phone:561-702-7884
Mailing Address - Fax:561-629-9356
Practice Address - Street 1:1609 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6644
Practice Address - Country:US
Practice Address - Phone:561-702-7884
Practice Address - Fax:561-629-9356
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12655225X00000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2511805Medicare PIN