Provider Demographics
NPI:1417207457
Name:LEWIS ELLIS, TONI T
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:T
Last Name:LEWIS ELLIS
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 1:1505 SILENT SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2012
Mailing Address - Country:US
Mailing Address - Phone:702-499-4509
Mailing Address - Fax:
Practice Address - Street 1:1505 SILENT SUNSET AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2012
Practice Address - Country:US
Practice Address - Phone:702-499-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant