Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 5258 | AL |
Y | 225XM0800X | Mental Health | 5258 | AL |
NPI | 1457945214 |
---|---|
Provider Name | Mrs. Michelle Ellis |
First Address | Huntsville, AL 35801-7415 |
Second Address | Huntsville, AL 35801-7415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2021 |
Last Update Date | 23/02/2021 |