Provider Demographics
NPI:1821093295
Name:MCGEE, ELISABETH CULLUM (OT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:CULLUM
Last Name:MCGEE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-858-6418
Mailing Address - Fax:904-858-6490
Practice Address - Street 1:14985 OLD ST. AUGUSTINE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258
Practice Address - Country:US
Practice Address - Phone:904-288-9491
Practice Address - Fax:904-288-9698
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11690225X00000X
FLPT22083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist