Provider Demographics
NPI:1417119751
Name:NELLIGAN, TRISHA (OT)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:TULLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1203 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3768
Mailing Address - Country:US
Mailing Address - Phone:386-341-3749
Mailing Address - Fax:
Practice Address - Street 1:1203 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3768
Practice Address - Country:US
Practice Address - Phone:386-341-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist