MEDICARE: MS. ELLEN L VAUGHT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT2300	CA
2	225X00000X	Occupational Therapist	OT004503	GA

General Provider Information

NPI Number	:	1356438287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN L VAUGHT OTR/L

Provider Business Mailing Address
First Line	:	269 CHEROKEE FARMS DR
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30263-7115
Country	:	US
Telephone Number	:	770-252-4453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 CLEVELAND AVE
Second Line	:	SUITE 1A
City	:	EAST POINT
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	678-783-7845
Fax Number	:	404-973-3256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	05/28/2013

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