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General NPI Number Information
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NPI Number | 1285470658
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Entity Type | Individual
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Provider Name | ELLA DORON RBT
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Gender | Female
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Dates
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Enumeration Date | 07/05/2024
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2626 SAINT JOE CENTER RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-5042
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Country | US
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Telephone | 260-497-0328
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Fax |
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Provider Business Mailing Address
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Address Line | 2626 SAINT JOE CENTER RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-5042
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Country | US
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Telephone | 260-497-0328
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 32003885A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-356739
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License Number State | IN
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