Healthcare Provider Details

I. General information

NPI: 1750387247
Provider Name (Legal Business Name): ELLEN L KITTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 NATIONAL RD
WHEELING WV
26003-5705
US

IV. Provider business mailing address

1305 NATIONAL RD
WHEELING WV
26003-5705
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-1390
  • Fax: 304-243-5880
Mailing address:
  • Phone: 304-242-1390
  • Fax: 304-243-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number13871
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35045295
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number13871
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number35045295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: