Active NPI
Rachel Dawn Ellis, OTR/L
- Occupational Therapist
- Kingsport, TN
National Provider Identifier
1831588417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 3716
- Practice address
- 1300 Bloomingdale Pike
Kingsport, TN 37660-2685 - Phone
- (865) 531-2204
- NPI assigned
- Jan 20, 2015
- 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 Therapist | 225X00000X | 3716 | TN | Primary |
Addresses
Primary practice location
1300 Bloomingdale Pike
Kingsport, TN 37660-2685
Mailing address
161 Treadway Dr
Johnson City, TN 37601-6229
Phone (423) 794-0958
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 |
|---|---|---|---|
| 3716 | TN | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421712000000",
"number": "1831588417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 TREADWAY DR",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376016229",
"telephone_number": "423-794-0958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 BLOOMINGDALE PIKE",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376602685",
"telephone_number": "865-531-2204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "RACHEL",
"middle_name": "DAWN",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-20",
"last_updated": "2015-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TN",
"license": "3716",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.