Individual
KATHLEEN LLOYD ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(336) 509-2992
Mailing address
1059 PARK WEST DR, CHARLOTTE, NC 28209-1398
(336) 509-2992
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
16759
NC
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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