Provider Demographics
NPI:1205885654
Name:TESLOVICH, ELAINE C (OTR/L)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:C
Last Name:TESLOVICH
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 1:1200 LEXINGTON GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1013
Mailing Address - Country:US
Mailing Address - Phone:407-322-3442
Mailing Address - Fax:407-322-8404
Practice Address - Street 1:617 CANAL ST STE B&C
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA
Practice Address - State:FL
Practice Address - Zip Code:32168-6901
Practice Address - Country:US
Practice Address - Phone:386-410-6903
Practice Address - Fax:386-402-7459
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADI562763-NA1Medicare ID - Type UnspecifiedMEDICARE INDIV OT NUMBER