Provider Demographics
NPI:1932697679
Name:ELIZE, DATHY-ANDELE
Entity Type:Individual
Prefix:
First Name:DATHY-ANDELE
Middle Name:
Last Name:ELIZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 NW 14TH CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6131
Mailing Address - Country:US
Mailing Address - Phone:954-515-2343
Mailing Address - Fax:
Practice Address - Street 1:1380 N KROME AVE STE 110
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-2406
Practice Address - Country:US
Practice Address - Phone:305-247-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT19097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty