Provider Demographics
NPI:1538715933
Name:ELLIOTT, OVIEDA PERRA (MA)
Entity type:Individual
Prefix:
First Name:OVIEDA
Middle Name:PERRA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21379 VELINO LN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6419
Mailing Address - Country:US
Mailing Address - Phone:707-498-8351
Mailing Address - Fax:
Practice Address - Street 1:9500 CORKSCREW PALMS CIR STE 5
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3307
Practice Address - Country:US
Practice Address - Phone:707-498-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16005OtherSPEECH PATHOLOGY