Michelle Lee Ellis, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OC00001159 Issued in WA

Practice address

5821 N Hermosa Cir
Otis Orchards, WA 99027-8278

Phone

(509) 209-6836

NPI assigned

Dec 13, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355356800000",
    "number": "1013253426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5821 N HERMOSA CIR",
            "city": "OTIS ORCHARDS",
            "state": "WA",
            "postal_code": "990278278",
            "telephone_number": "509-209-6836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5821 N HERMOSA CIR",
            "city": "OTIS ORCHARDS",
            "state": "WA",
            "postal_code": "990278278",
            "telephone_number": "509-209-6836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MICHELLE",
        "middle_name": "LEE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-13",
        "last_updated": "2012-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "WA",
            "license": "OC00001159",
            "primary": true
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "ID",
            "license": "OTA-228",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Bergenske, O.D.
• Lori Sue Burke, M.A. CCC-SLP
• Carla Mae Carnegie, MT-BC
• Ashley Nicole Ceresa, JD, LMSW
• Maryln A Clary
• Ember DPT PLLC
• Anna Vitalevna Fomin
• Kerri C Miller, LMP
• Jozlinn Rae, IDMT
• Renegade Healing Co., LLC

• Occupational Therapy Assistant in Otis Orchards, WA
• Providers in Otis Orchards, WA by specialty
• Occupational Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.