Provider Demographics
NPI:1285826768
Name:ELLIS, AMY DIANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
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 1:124 LOUGHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1422
Mailing Address - Country:US
Mailing Address - Phone:724-846-5887
Mailing Address - Fax:724-846-1867
Practice Address - Street 1:124 LOUGHRIDGE DR
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1422
Practice Address - Country:US
Practice Address - Phone:724-846-5887
Practice Address - Fax:724-846-1867
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002925L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist