Individual
MISS LACIE TAYLOR ELLITHORPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
4902 CREEKSIDE DR STE A, CLEARWATER, FL 33760-4033
(727) 592-9100
(727) 592-9109
Mailing address
2717 SEVILLE BLVD APT 10106, CLEARWATER, FL 33764-1174
(239) 677-1166
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT23659
FL
225X00000X
Occupational Therapist
—
FL
Other
Enumeration date
12/23/2019
Last updated
11/11/2022
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