Provider Demographics
NPI:1932273653
Name:MITCHELL, ELLEN L (OTR)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:MITCHELL
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 1:828 VALERIE PL
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6426
Mailing Address - Country:US
Mailing Address - Phone:229-247-4673
Mailing Address - Fax:
Practice Address - Street 1:828 VALERIE PL
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6426
Practice Address - Country:US
Practice Address - Phone:229-247-4673
Practice Address - Fax:229-247-4673
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0043225X00000X
FL0005914225X00000X
GAOT003572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist