Provider Demographics
NPI:1578847984
Name:ELLIS, AMY LYNN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13664-3219
Mailing Address - Country:US
Mailing Address - Phone:315-375-6383
Mailing Address - Fax:
Practice Address - Street 1:204 HIGH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NY
Practice Address - Zip Code:13664-3219
Practice Address - Country:US
Practice Address - Phone:315-375-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7297915225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist