Individual
MR. MARK BRYAN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
9601 INTERSTATE 630 EXIT 7, LITTLE ROCK, AR 72205-7202
(501) 202-7598
Mailing address
250 LORENE ST, AUSTIN, AR 72007-9137
(501) 605-8113
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR567
AR
Other
Enumeration date
11/03/2008
Last updated
11/03/2008
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