Provider Demographics
NPI:1447562715
Name:ELLI, LINDA LEA (MA, OTR/L, DSII)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LEA
Last Name:ELLI
Suffix:
Gender:F
Credentials:MA, OTR/L, DSII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 TULIP RD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3858
Mailing Address - Country:US
Mailing Address - Phone:505-896-8095
Mailing Address - Fax:
Practice Address - Street 1:916 TULIP RD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3858
Practice Address - Country:US
Practice Address - Phone:505-896-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1035225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist