Most Relevant Information
Provider Data
| NPI Number: | 1003075417 |
| Provider Name: | NICOLE ELLEDGE OTR |
| Entity Type: | Individual |
| Taxonomy Code: | 225X00000X |
| Specialty: | Occupational Therapist |
| License Number: | 1060547 |
Most Important Dates
| Enumeration Date: | 06/02/2008 |
| Last Updated: | 05/06/2022 |
Provider Practice Location
3900 KRUSE WAY PL
LAKE OSWEGO
OR
970352512
Practice Location Phone/Fax
| Phone: | 5036070566 |
| Fax: |
Provider Mailing Location
23532 SW STONEHAVEN ST
SHERWOOD
OR
971407076
Provider Mailing Phone/Fax
| Phone: | 9717322991 |
| Fax: |