Active NPI
Crystal R Ellis, OT
- Specialist
- Monroe, LA
National Provider Identifier
1487969168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- Z12381
- Practice address
- 1828 Tower Dr
Monroe, LA 71201-4938 - Phone
- (318) 338-2081
- Fax
- (318) 699-8954
- NPI assigned
- Aug 18, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Z12381 | LA | Primary |
Addresses
Primary practice location
1828 Tower Dr
Monroe, LA 71201-4938
Mailing address
109 Castor CV
Calhoun, LA 71225-9301
Phone (318) 644-2797
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Z12381 | LA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282089600000",
"number": "1487969168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 CASTOR CV",
"city": "CALHOUN",
"state": "LA",
"postal_code": "712259301",
"telephone_number": "318-644-2797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1828 TOWER DR",
"city": "MONROE",
"state": "LA",
"postal_code": "712014938",
"telephone_number": "318-338-2081",
"fax_number": "318-699-8954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CRYSTAL",
"middle_name": "R",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-18",
"last_updated": "2010-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "LA",
"license": "Z12381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.