Provider Demographics
NPI:1356438287
Name:VAUGHT, ELLEN L (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:L
Last Name:VAUGHT
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 1:269 CHEROKEE FARMS DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-7115
Mailing Address - Country:US
Mailing Address - Phone:770-252-4453
Mailing Address - Fax:
Practice Address - Street 1:1203 CLEVELAND AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3417
Practice Address - Country:US
Practice Address - Phone:678-783-7845
Practice Address - Fax:404-973-3256
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2300225X00000X
GAOT004503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist