Provider Demographics
NPI:1679187470
Name:GARCIA, BRICKELL ELISABETH (MOTR/L)
Entity Type:Individual
Prefix:
First Name:BRICKELL
Middle Name:ELISABETH
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:BRICKELL
Other - Middle Name:ELISABETH
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT
Mailing Address - Street 1:246 STEVENAGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4555
Mailing Address - Country:US
Mailing Address - Phone:407-234-3849
Mailing Address - Fax:
Practice Address - Street 1:315 6TH ST S
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1828
Practice Address - Country:US
Practice Address - Phone:205-274-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist