Provider Demographics
NPI:1174953624
Name:TERRELL, ELLEN (OTR/L)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:TERRELL
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 1:123 SEDALIA CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3760
Mailing Address - Country:US
Mailing Address - Phone:770-475-8668
Mailing Address - Fax:770-475-8668
Practice Address - Street 1:10050 CRABAPPLE ROAD
Practice Address - Street 2:SUITE D-115A
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075
Practice Address - Country:US
Practice Address - Phone:770-642-0670
Practice Address - Fax:770-642-0706
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist