Individual
JESSI ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1350 14TH AVE SE, DECATUR, AL 35601-4364
(256) 355-6911
Mailing address
5112 COUNTY ROAD 109, BREMEN, AL 35033-3519
(256) 783-1134
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5999
AL
Other
Enumeration date
07/03/2015
Last updated
07/03/2015
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