Provider Demographics
NPI:1922339910
Name:ELLIS, NANCY B (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:B
Last Name:ELLIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 LORENE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-9137
Mailing Address - Country:US
Mailing Address - Phone:501-519-6486
Mailing Address - Fax:
Practice Address - Street 1:250 LORENE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:AR
Practice Address - Zip Code:72007-9137
Practice Address - Country:US
Practice Address - Phone:501-519-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist