Individual provider Active NPI

Ethan Zellers, OTD, OTR/L

  • Occupational Therapist
  • Louisville, KY
National Provider Identifier
1740026699
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT012905 Issued in OH
Practice address
2701 Chestnut Station CT
Louisville, KY 40299-6395
Phone
(180) 033-5106
NPI assigned
Jul 1, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT012905 OH Primary

Addresses

Primary practice location

2701 Chestnut Station CT
Louisville, KY 40299-6395

Mailing address

11197 Tritts St NW
Canal Fulton, OH 44614-9601
Phone (330) 329-0356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240730000450 OH Practitioner - Occupational Therapist in Private Practice 8426595240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paragon Outpatient Rehabilitation Services LLCGroup PAC ID 8022272848, 199 clinicians

Practice addresses (Care Compare)

767 Loveland Miamiville Rd
Loveland, OH 45140-0018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OT012905OHMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Outpatient Rehabilitation Services, LLC CurrentSince Jul 1, 2024 Accepting new patients
Paragon Outpatient Rehabilitation Services, LLC CurrentSince Jul 1, 2024 Accepting new patients

Locations

303 N Hurstbourne Pkwy
Ste 200
Louisville, KY 40222
Phone (502) 213-7572

2701 Chestnut Station Ct
Louisville, KY 40299
Phone (502) 964-5359

47 Steeplechase Ln
Munroe Falls, OH 44262
Phone (234) 334-0705

60 Paceline Cir
Xenia, OH 45385
Phone (937) 372-1530

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1740026699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11197 TRITTS ST NW",
            "city": "CANAL FULTON",
            "state": "OH",
            "postal_code": "446149601",
            "telephone_number": "330-329-0356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 CHESTNUT STATION CT",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402996395",
            "telephone_number": "180-033-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZELLERS",
        "first_name": "ETHAN",
        "credential": "OTD, OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OH",
            "license": "OT012905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.