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General NPI Number Information
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NPI Number | 1184988537
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Entity Type | Individual
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Provider Name | DEBORAH S ELLSWORTH MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 3 PINTO LN
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City | LANDER
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State | WY
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Zip | 82520-9756
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Country | US
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Telephone | 307-714-4086
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Fax | 307-335-6539
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Provider Business Mailing Address
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Address Line | 3 PINTO LN
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City | LANDER
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State | WY
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Zip | 82520-9756
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Country | US
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Telephone | 307-714-4086
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Fax | 307-335-6539
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 99
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License Number State | WY
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