Provider Demographics
NPI:1568435238
Name:BRUCE, ELLEN K (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:K
Last Name:BRUCE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72727-0778
Mailing Address - Country:US
Mailing Address - Phone:479-677-3317
Mailing Address - Fax:479-521-5439
Practice Address - Street 1:2474 E JOYCE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4519
Practice Address - Country:US
Practice Address - Phone:479-409-5067
Practice Address - Fax:479-521-5439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR582225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T726OtherBCBS INDIVIDUAL NUMBER