Provider Demographics
NPI:1629202320
Name:ELLIS, ARDITH K (LMT)
Entity Type:Individual
Prefix:MS
First Name:ARDITH
Middle Name:K
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 N MAIN ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1182
Mailing Address - Country:US
Mailing Address - Phone:440-773-5788
Mailing Address - Fax:
Practice Address - Street 1:7 N MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1182
Practice Address - Country:US
Practice Address - Phone:440-773-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9078175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34192227400OtherWORKERS COMPENSATION