Healthcare Provider Details

I. General information

NPI: 1184453326
Provider Name (Legal Business Name): ELLEN CULLEN OT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2024
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 MONROE AVE STE 105
ROCHESTER NY
14618-4726
US

IV. Provider business mailing address

142 HIGHLEDGE DR
PENFIELD NY
14526-2449
US

V. Phone/Fax

Practice location:
  • Phone: 585-645-7364
  • Fax:
Mailing address:
  • Phone: 585-645-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLEN CULLEN
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, MS, OTR/L, BCP
Phone: 585-645-7364