Provider Demographics
NPI:1124856034
Name:KOTT, ELLEN ANNE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANNE
Last Name:KOTT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FOLSOM AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1015
Mailing Address - Country:US
Mailing Address - Phone:631-793-4520
Mailing Address - Fax:
Practice Address - Street 1:51 FOLSOM AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1015
Practice Address - Country:US
Practice Address - Phone:631-793-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015958-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty