Provider Demographics
NPI:1164652210
Name:COUNTY, ELLEN MARIE
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:MARIE
Last Name:COUNTY
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 1:111 LORING AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6651
Mailing Address - Country:US
Mailing Address - Phone:207-312-9532
Mailing Address - Fax:
Practice Address - Street 1:111 LORING AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6651
Practice Address - Country:US
Practice Address - Phone:207-312-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist