Provider Demographics
NPI:1902986599
Name:ELLS, VIRGINIA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 BOSTON POST RD
Mailing Address - Street 2:YALE OUTPATIENT OT
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4338
Mailing Address - Country:US
Mailing Address - Phone:203-458-5200
Mailing Address - Fax:203-458-5201
Practice Address - Street 1:1445 BOSTON POST RD
Practice Address - Street 2:YALE OUTPATIENT OT
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4338
Practice Address - Country:US
Practice Address - Phone:203-458-5200
Practice Address - Fax:203-458-5201
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000416225X00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand