Provider Demographics
NPI:1710169305
Name:ELLIS, ERIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ELLIS
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 1:76 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3315
Mailing Address - Country:US
Mailing Address - Phone:508-898-2688
Mailing Address - Fax:508-319-3200
Practice Address - Street 1:104 HARRINGTON AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5248
Practice Address - Country:US
Practice Address - Phone:508-898-2688
Practice Address - Fax:508-319-3200
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist