Nicole Elledge, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

1060547 Issued in OR

Practice address

3900 Kruse Way PL
Lake Oswego, OR 97035-2512

Phone

(503) 607-0566

NPI assigned

Jun 2, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

TSL Well LLCGroup PAC ID 0345776050, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• TSL Well LLC

  • Physical Therapist
  • Lake Oswego, OR
  • NPI 1730915083
  Medicare reassignment Care Compare group NPD
• Premere Rehab LLC

  • Physical Therapist
  • Wilsonville, OR
  • NPI 1245278639

  Occupational Therapist

  Medicare reassignment NPD
• Premere Rehab LLC

  • Physical Therapist
  • Eugene, OR
  • NPI 1255739900

  Occupational Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1003075417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23532 SW STONEHAVEN ST",
            "city": "SHERWOOD",
            "state": "OR",
            "postal_code": "971407076",
            "telephone_number": "971-732-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 KRUSE WAY PL",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352512",
            "telephone_number": "503-607-0566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Fulton St",
            "address_purpose": "LOCATION",
            "city": "Newberg",
            "state": "OR",
            "postal_code": "971321806",
            "country_code": "US",
            "telephone_number": "503-538-2108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLEDGE",
        "first_name": "NICOLE",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-02",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OR",
            "license": "1060547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Edwards, LCSW
• Stephen Eguia
• Karrie Marie J Ehlers, PSYD
• Walied Eldomiaty, DDS
• Elisa a. Burgess, MD, PC
• John F Elliott
• Megan Elliott, MT-BC
• Tamara M Ellis, PHH (MFT)
• Mitchell Scott Elovitz, LPC
• Kathryn Emard, MS, NCC, QMHP

• Occupational Therapist in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Occupational Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.