Provider Demographics
NPI:1023769650
Name:CARR, ELAINA
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:CARR
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 1:930 N FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-1706
Mailing Address - Country:US
Mailing Address - Phone:850-331-2987
Mailing Address - Fax:850-398-5008
Practice Address - Street 1:831 MCCASKILL ST
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-2757
Practice Address - Country:US
Practice Address - Phone:850-634-6243
Practice Address - Fax:850-801-1118
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21974225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics