Individual
MS. LAUREN ELIZABETH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1740 S WALNUT ST, PAULS VALLEY, OK 73075-6919
(405) 222-8716
Mailing address
1740 S WALNUT ST, PAULS VALLEY, OK 73075-6919
(405) 222-8716
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1528
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528
OKLAHOMA MEDICAL BOARD LISCENSE COTA/L
OK
Enumeration date
05/15/2017
Last updated
07/21/2022
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