Healthcare Provider Details

I. General information

NPI: 1881559425
Provider Name (Legal Business Name): JACKEE ELLIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 S CONGRESS AVE STE 202
PALM SPRINGS FL
33461-4762
US

IV. Provider business mailing address

818 8TH TER
PALM BEACH GARDENS FL
33418-3638
US

V. Phone/Fax

Practice location:
  • Phone: 561-762-9477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT12841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: