Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OC00001159 | WA |
N | 224Z00000X | Occupational Therapy Assistant | OTA-228 | ID |
NPI | 1013253426 |
---|---|
Provider Name | Michelle Lee Ellis |
First Address | Otis Orchards, WA 99027-8278 |
Second Address | Otis Orchards, WA 99027-8278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2012 |
Last Update Date | 13/12/2012 |