Nicole Ellsworth

NPI #1053860536 in Southbridge, Massachusetts

Provider Information

NPI Number: 1053860536
Entity Type: Individual
Name: Nicole Ellsworth
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Developmental Therapist
Enumeration Date: Sep 26, 2016
Last Updated: Sep 26, 2016

Practice Location

Address: 486 WORCESTER ST
Address 2: KENNEDY DONOVAN CENTER
City: Southbridge
State: Massachusetts
ZIP Code: 01550-1386
Phone: (508) 367-2338

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Developmental Therapist	222Q00000X	Primary

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