Provider Demographics
NPI:1326543935
Name:SANDERS, ELLEN PATRICIA (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:PATRICIA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PHEASANT RUN DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-6865
Mailing Address - Country:US
Mailing Address - Phone:517-526-0703
Mailing Address - Fax:
Practice Address - Street 1:2815 S PENNSYLVANIA AVE STE 4
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3496
Practice Address - Country:US
Practice Address - Phone:800-722-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006252A225X00000X
MI5201009676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist