Individual
MRS. THERESA DENISE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
202 MAGNOLIA BLUFF DR, COLUMBIA, SC 29229-7529
(803) 419-7413
Mailing address
202 MAGNOLIA BLUFF DR, COLUMBIA, SC 29229-7529
(803) 419-7413
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1007
SC
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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