Provider Demographics
NPI:1497179600
Name:ELLIS, CHELSEA DIANE (OTR/L)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:DIANE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 RAND AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9126
Mailing Address - Country:US
Mailing Address - Phone:251-210-1632
Mailing Address - Fax:251-625-3152
Practice Address - Street 1:8909 RAND AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9126
Practice Address - Country:US
Practice Address - Phone:251-210-1632
Practice Address - Fax:251-625-3152
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3748225X00000X
NC9471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist