Provider Demographics
NPI:1487787834
Name:RYAN, ELIZABETH COLEEN (OTR)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:COLEEN
Last Name:RYAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 SE OCEAN BLVD
Mailing Address - Street 2:SUITE 104C
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2511
Mailing Address - Country:US
Mailing Address - Phone:917-817-7965
Mailing Address - Fax:772-286-6353
Practice Address - Street 1:1001 SE OCEAN BLVD
Practice Address - Street 2:SUITE 104C
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2511
Practice Address - Country:US
Practice Address - Phone:917-817-7965
Practice Address - Fax:772-286-6353
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist