Individual
LISA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
197 PIEDMONT BLVD STE 205, ROCK HILL, SC 29732-1846
(803) 639-8066
(803) 366-7755
Mailing address
2675 COURT DR, GASTONIA, NC 28054-1478
(704) 824-7800
(704) 824-2822
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5090
SC
225X00000X
Occupational Therapist
8079
NC
Other
Enumeration date
09/17/2013
Last updated
03/17/2018
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