Provider Demographics
NPI:1598960007
Name:ELM OCCUPATIONAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ELM OCCUPATIONAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:229-247-4673
Mailing Address - Street 1:828 VALERIE PL
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6426
Mailing Address - Country:US
Mailing Address - Phone:229-247-4673
Mailing Address - Fax:229-247-4673
Practice Address - Street 1:828 VALERIE PL
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6426
Practice Address - Country:US
Practice Address - Phone:229-247-4673
Practice Address - Fax:229-247-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003572 GA225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty