Provider Demographics
NPI:1326389297
Name:ELLIS, CHERLYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHERLYN
Middle Name:
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 1:3500 CARLTON AVE UNIT L40
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5717
Mailing Address - Country:US
Mailing Address - Phone:970-222-2845
Mailing Address - Fax:
Practice Address - Street 1:3500 CARLTON AVE UNIT L40
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5717
Practice Address - Country:US
Practice Address - Phone:970-222-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist