Basic Information
| Provider Information | |||||||||
| NPI: | 1679187470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | BRICKELL | ||||||||
| MiddleName: | ELISABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MOTR/L | ||||||||
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| OtherLastName: | GARCIA | ||||||||
| OtherFirstName: | BRICKELL | ||||||||
| OtherMiddleName: | ELISABETH | ||||||||
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| OtherCredential: | MOT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 246 STEVENAGE DR | ||||||||
| Address2: | |||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327794555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072343849 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 315 6TH ST S | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351211828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052742244 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2020 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 5020 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.