Individual
LISA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOT
Contact information
Practice address
3400 WILSON AVE SW, GRANDVILLE, MI 49418
(616) 534-5487
Mailing address
2020 S CROSS CREEK DR SE, GRAND RAPIDS, MI 49508-8780
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201009335
MI
Other
Enumeration date
09/29/2015
Last updated
08/30/2018
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