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General NPI Number Information
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NPI Number | 1629588470
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Entity Type | Individual
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Provider Name | BRITNIE ELLIS
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Gender | Female
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 4315 1ST AVE NE
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City | BRADENTON
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State | FL
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Zip | 34208-5431
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Country | US
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Telephone | 941-284-2138
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Fax |
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Provider Business Mailing Address
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Address Line | 605 131ST ST E
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City | BRADENTON
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State | FL
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Zip | 34212-9197
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Country | US
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Telephone |
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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 | OT18727
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License Number State | FL
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