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Individual

JACOB BRANNON ELLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
97 HUGHES RD STE H, MADISON, AL 35758-3401
(256) 883-7338
(256) 883-7135
Mailing address
97 HUGHES RD STE H, MADISON, AL 35758-3401
(256) 883-7338
(256) 883-7135

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4316
AL

Other

Enumeration date
10/31/2017
Last updated
10/31/2017
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