Individual
BETHANY ANNE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S
Contact information
Practice address
100 ERDMAN WAY, LEOMINSTER, MA 01453-1804
(978) 840-9354
Mailing address
44 CAMBRIDGE ST, APT #4, AYER, MA 01432-1361
(978) 772-1274
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
392110
MA
Other
Enumeration date
11/13/2007
Last updated
11/13/2007
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