Individual
MRS. LAVON ELLIS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2636 S MILFORD RD, HIGHLAND, MI 48357-4938
(248) 684-9610
(248) 684-9611
Mailing address
18409 GRAYFIELD, DETROIT, MI 48219
(313) 532-5538
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202002716
MI
Other
Enumeration date
06/06/2007
Last updated
07/08/2007
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