Provider Demographics
NPI:1053142620
Name:ELLAVATING YOU
Entity type:Organization
Organization Name:ELLAVATING YOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTR
Authorized Official - Phone:256-740-1236
Mailing Address - Street 1:3607 BEAVER RUN
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-6767
Mailing Address - Country:US
Mailing Address - Phone:256-740-1236
Mailing Address - Fax:
Practice Address - Street 1:3607 BEAVER RUN
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-6767
Practice Address - Country:US
Practice Address - Phone:256-740-1236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty