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Individual

MRS. ASHLEY MICHELLE ELLISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
207 W CONWAY ST., BENTON, AR 72015
(501) 778-4861
(501) 776-5777
Mailing address
207 W CONWAY ST., BENTON, AR 72015
(501) 778-4861
(501) 776-5777

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A776
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
199525721
AR
01
OT-A776
COTA LIC #
AR
Enumeration date
09/18/2013
Last updated
01/18/2024
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