Individual
ELLIS DADE MUMFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
13900 HULL STREET RD, MIDLOTHIAN, VA 23112-2004
(804) 639-8668
Mailing address
3810 W BROAD ST UNIT 1342, RICHMOND, VA 23230-3968
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
08/09/2023
Last updated
08/09/2023
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