Individual
KAELYNN DENISE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1112 GALLIA ST, PORTSMOUTH, OH 45662-4161
(740) 440-2281
Mailing address
1112 GALLIA ST, PORTSMOUTH, OH 45662-4161
(740) 440-2281
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
012059
OH
Other
Enumeration date
07/05/2022
Last updated
07/05/2022
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