Basic Information
| Provider Information | |||||||||
| NPI: | 1205429701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIS | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6298 FIELDSTONE DR | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450408931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137209092 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 MALLARD COVE DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452463941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138305014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2021 | ||||||||
| LastUpdateDate: | 02/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 011366 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.