Provider Demographics
NPI:1669746269
Name:ELLIS, ROBERT (OT/L, CHT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ELLIS
Suffix:
Gender:M
Credentials:OT/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 N ORACLE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4237
Mailing Address - Country:US
Mailing Address - Phone:520-219-5825
Mailing Address - Fax:520-219-5827
Practice Address - Street 1:6970 N ORACLE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4237
Practice Address - Country:US
Practice Address - Phone:520-219-5825
Practice Address - Fax:520-219-5827
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist