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General NPI Number Information
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NPI Number | 1700058617
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Entity Type | Individual
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Provider Name | AARON JASON ELLIS OTR/L
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Gender | Male
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 15549 117TH CT
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City | ORLAND PARK
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State | IL
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Zip | 60467-5878
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Country | US
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Telephone | 708-224-1032
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Fax |
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Provider Business Mailing Address
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Address Line | 15221 HUNTINGTON CT
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City | ORLAND PARK
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State | IL
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Zip | 60462-3532
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Country | US
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Telephone | 708-224-1032
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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 | 056.006462
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License Number State | IL
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