Provider Demographics
NPI:1780811802
Name:ELLIS, RACHEL ANNE (MS, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:ANNE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FARMSTEAD LANE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803
Mailing Address - Country:US
Mailing Address - Phone:814-954-7045
Mailing Address - Fax:
Practice Address - Street 1:150 FARMSTEAD LANE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-954-7045
Practice Address - Fax:814-954-7042
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist