Individual
MEGAN GRACE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
16171 N BRINSON ST, NAMPA, ID 83687-5509
(208) 442-2525
(208) 442-2505
Mailing address
16171 N BRINSON ST, NAMPA, ID 83687-5509
(208) 442-2525
(208) 442-2505
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1735
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-1735
STATE LICENSE
ID
Enumeration date
04/14/2017
Last updated
04/14/2017
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