Provider Demographics
NPI:1477334662
Name:ELY, TODD CHRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:CHRISTOPHER
Last Name:ELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W BAKER RD STE C
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2365
Mailing Address - Country:US
Mailing Address - Phone:281-422-4292
Mailing Address - Fax:
Practice Address - Street 1:1109 W BAKER RD STE C
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2365
Practice Address - Country:US
Practice Address - Phone:281-422-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80945237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist