Healthcare Provider Details

I. General information

NPI: 1144895061
Provider Name (Legal Business Name): REBECCA MICHELLE ELLISON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STILES RD
SALEM NH
03079-4859
US

IV. Provider business mailing address

3 CHAMPLAIN DR
HUDSON MA
01749-3106
US

V. Phone/Fax

Practice location:
  • Phone: 855-390-7774
  • Fax:
Mailing address:
  • Phone: 978-509-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number3172
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number9197
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: