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Individual
MISTY KAYE ELLERBE
Active
Individual
MISTY KAYE ELLERBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OT-A626
AR
225X00000X
Occupational Therapist
Primary
OTR2910
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-A626
AR LICENSE
AR
Enumeration date
01/13/2016
Last updated
11/25/2020
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