Provider Demographics
NPI:1417697012
Name:HART, ELLA ROCHELLE (COMS, CLVT)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:ROCHELLE
Last Name:HART
Suffix:
Gender:F
Credentials:COMS, CLVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 MCKESIE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35135-1135
Mailing Address - Country:US
Mailing Address - Phone:205-490-4651
Mailing Address - Fax:
Practice Address - Street 1:700 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1927
Practice Address - Country:US
Practice Address - Phone:205-490-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind