Individual
MRS. AMY DIANE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1900 PARR AVE, DYERSBURG, TN 38024-2009
(731) 286-1221
Mailing address
2009 WELCH RD, DYERSBURG, TN 38024-7740
(731) 445-8822
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2094
TN
Other
Enumeration date
04/24/2012
Last updated
03/07/2021
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