Active NPI
Laken Ellis, OTR/L
- Occupational Therapist
- Cordova, TN
National Provider Identifier
1760076004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 6659
- Practice address
- 146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396 - Phone
- (901) 654-5693
- NPI assigned
- Feb 26, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 6659 | TN | Primary |
Addresses
Primary practice location
146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396
Mailing address
3971 Knight Arnold Rd
Memphis, TN 38118-3004
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6659 | TN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MTG2 | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
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": "1614297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668470400000",
"number": "1760076004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3971 KNIGHT ARNOLD RD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381183004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 TIMBER CREEK DR STE 101",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380184396",
"telephone_number": "901-654-5693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "LAKEN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-26",
"last_updated": "2022-11-15",
"certification_date": "2022-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TN",
"license": "6659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.