Provider Demographics
NPI:1073368767
Name:SCHUYTEN, ELISE NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:NICOLE
Last Name:SCHUYTEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7381 NAVARRE PKWY UNIT 5409
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8454
Mailing Address - Country:US
Mailing Address - Phone:225-485-1847
Mailing Address - Fax:
Practice Address - Street 1:4595 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8847
Practice Address - Country:US
Practice Address - Phone:850-460-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist