Individual
EDITH SELDEN EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4 JACKSON ST NE, FORT WALTON BEACH, FL 32548-4925
(850) 862-7227
Mailing address
501 BLACKWATER RUN, NICEVILLE, FL 32578-1642
(850) 678-6400
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
9614
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT10239
FLORIDA LICENSE (OT)
FL
Enumeration date
10/25/2006
Last updated
07/08/2007
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