Healthcare Provider Details

I. General information

NPI: 1427995182
Provider Name (Legal Business Name): JORDAN ELLINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 SMITH LN
MOUNT HOLLY NJ
08060-1003
US

IV. Provider business mailing address

416 SMITH LN
MOUNT HOLLY NJ
08060-1003
US

V. Phone/Fax

Practice location:
  • Phone: 281-743-0284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number46TR01180200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: