Provider Demographics
NPI:1326452715
Name:ELLINGTON, MARIAN DENISE (OTR, MOT)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:DENISE
Last Name:ELLINGTON
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 1:6000 ELDORADO PKWY APT 931
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3556
Mailing Address - Country:US
Mailing Address - Phone:205-601-2573
Mailing Address - Fax:
Practice Address - Street 1:1301 JUSTIN RD STE 206
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2150
Practice Address - Country:US
Practice Address - Phone:972-317-7775
Practice Address - Fax:972-317-6356
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115357225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics