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General NPI Number Information
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NPI Number | 1356438287
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Entity Type | Individual
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Provider Name | ELLEN L VAUGHT OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 1203 CLEVELAND AVE SUITE 1A
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City | EAST POINT
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State | GA
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Zip | 30344-3417
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Country | US
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Telephone | 678-783-7845
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Fax | 404-973-3256
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Provider Business Mailing Address
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Address Line | 269 CHEROKEE FARMS DR
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City | NEWNAN
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State | GA
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Zip | 30263-7115
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Country | US
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Telephone | 770-252-4453
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT2300
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT004503
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License Number State | GA
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