Provider Demographics
NPI:1922440304
Name:KONSOL, ELLEN ROBYN (OTR)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ROBYN
Last Name:KONSOL
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 1:5798 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1826
Mailing Address - Country:US
Mailing Address - Phone:248-724-4000
Mailing Address - Fax:248-724-4405
Practice Address - Street 1:1349 S ROCHESTER RD
Practice Address - Street 2:STE 215
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3150
Practice Address - Country:US
Practice Address - Phone:248-218-5150
Practice Address - Fax:248-218-5155
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist