Individual
MR. NATHAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
139 OUTER STATE ST. RD, CANTON, NY 13617
(315) 386-4504
Mailing address
204 HIGH ST, MORRISTOWN, NY 13664-3219
(315) 375-6383
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
010670-1
NY
Other
Enumeration date
10/31/2011
Last updated
10/31/2011
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