Provider Demographics
NPI:1629463211
Name:MCELLEN, BRITTANY (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:MCELLEN
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP HARBOR
Mailing Address - State:IL
Mailing Address - Zip Code:60096-1846
Mailing Address - Country:US
Mailing Address - Phone:224-619-6822
Mailing Address - Fax:
Practice Address - Street 1:222 S RIVERSIDE PLZ STE 830
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5900
Practice Address - Country:US
Practice Address - Phone:866-386-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010952225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist