Individual
CRYSTAL R ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1828 TOWER DR, MONROE, LA 71201-4938
(318) 338-2081
(318) 699-8954
Mailing address
109 CASTOR CV, CALHOUN, LA 71225-9301
(318) 644-2797
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
Z12381
LA
Other
Enumeration date
08/18/2010
Last updated
08/18/2010
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