MEDICARE: CARYN ELLIS OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	10507	NC

General Provider Information

NPI Number	:	1235681628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARYN ELLIS OT

Provider Business Mailing Address
First Line	:	205 EMERALD POND LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-6051
Country	:	US
Telephone Number	:	919-371-2907
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 EMERALD POND LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-6051
Country	:	US
Telephone Number	:	919-371-2907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2016
Last Update Date	:	07/21/2022

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