Active NPI
Amy Diane Ellis, COTA/L
- Occupational Therapy Assistant
- Dyersburg, TN
National Provider Identifier
1831457191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 2094
- Practice address
- 1900 Parr Ave
Dyersburg, TN 38024-2009 - Phone
- (731) 286-1221
- NPI assigned
- Apr 24, 2012
- 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 |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2094 | TN | Primary |
Addresses
Primary practice location
1900 Parr Ave
Dyersburg, TN 38024-2009
Mailing address
2009 Welch Rd
Dyersburg, TN 38024-7740
Phone (731) 445-8822
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 |
|---|---|---|---|
| 2094 | TN | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615075200000",
"number": "1831457191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2009 WELCH RD",
"city": "DYERSBURG",
"state": "TN",
"postal_code": "380247740",
"telephone_number": "731-445-8822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 PARR AVE",
"city": "DYERSBURG",
"state": "TN",
"postal_code": "380242009",
"telephone_number": "731-286-1221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "AMY",
"middle_name": "DIANE",
"name_prefix": "Mrs.",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-24",
"last_updated": "2021-03-07",
"certification_date": "2021-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TN",
"license": "2094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyersburg, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.