Healthcare Provider Details

I. General information

NPI: 1518546662
Provider Name (Legal Business Name): JESSICA ELLIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SE 1ST AVE STE 200-41
OCALA FL
34471-2176
US

IV. Provider business mailing address

110 ASHWOOD WAY
EASLEY SC
29640-8001
US

V. Phone/Fax

Practice location:
  • Phone: 800-989-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: