Basic Information
| Provider Information | |||||||||
| NPI: | 1205885654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESLOVICH | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 LEXINGTON GREEN LN | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327711013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073223442 | ||||||||
| FaxNumber: | 4073228404 | ||||||||
| Practice Location | |||||||||
| Address1: | 617 CANAL ST STE B&C | ||||||||
| Address2: | |||||||||
| City: | NEW SMYRNA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321686901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3864106903 | ||||||||
| FaxNumber: | 3864027459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT18047 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.