Most Relevant Information
Provider Data
| NPI Number: | 1003069147 |
| Provider Name: | MARK BRYAN ELLIS OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | OTR567 |
Most Important Dates
| Enumeration Date: | 11/03/2008 |
| Last Updated: | 11/03/2008 |
Provider Practice Location
9601 INTERSTATE 630 EXIT 7
LITTLE ROCK
AR
722057202
Practice Location Phone/Fax
| Phone: | 5012027598 |
| Fax: |
Provider Mailing Location
250 LORENE ST
AUSTIN
AR
720079137
Provider Mailing Phone/Fax
| Phone: | 5016058113 |
| Fax: |