Provider Demographics
NPI:1437936085
Name:ELLING, JUNIOR LYNN (OTR/L, MHA)
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:LYNN
Last Name:ELLING
Suffix:
Gender:M
Credentials:OTR/L, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-9784
Mailing Address - Country:US
Mailing Address - Phone:815-842-4584
Mailing Address - Fax:815-842-6893
Practice Address - Street 1:2500 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9784
Practice Address - Country:US
Practice Address - Phone:815-842-4584
Practice Address - Fax:815-842-6893
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-002654225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist