Provider Demographics
NPI:1134656523
Name:TAN, ELLEN W (OTR, MOT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:W
Last Name:TAN
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4971 SWEETWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3133
Mailing Address - Country:US
Mailing Address - Phone:281-271-1330
Mailing Address - Fax:
Practice Address - Street 1:2637 LAZY BEND ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-1006
Practice Address - Country:US
Practice Address - Phone:281-485-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114629225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand