Individual
AUSTIN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1461 BROADWAY N, FARGO, ND 58102-2622
(701) 293-6037
Mailing address
1461 BROADWAY N, FARGO, ND 58102-2622
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2041
ND
Other
Enumeration date
08/22/2023
Last updated
08/22/2023
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