Provider Demographics
NPI:1083494207
Name:ELLIS, EMILY PARKER (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:PARKER
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 S BLACKHAWK ST APT 12305
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4314
Mailing Address - Country:US
Mailing Address - Phone:314-705-7108
Mailing Address - Fax:
Practice Address - Street 1:19284 COTTONWOOD DR STE 203
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3881
Practice Address - Country:US
Practice Address - Phone:720-788-7365
Practice Address - Fax:720-294-1426
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist