Individual
CHARLENE DENISE ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14200 LAUREL PARK DR, LAUREL, MD 20707-5201
(410) 792-4717
Mailing address
14200 LAUREL PARK DR, LAUREL, MD 20707-5201
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
MD
Other
Enumeration date
02/15/2019
Last updated
02/15/2019
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