Roberta Marie Nickell, OTRL

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

4966 Issued in CA

Practice address

4560 SE International Way
Suite 100 Consonus Healthcare Services
Milwaukie, OR 97222

Phone

(971) 206-5149

Fax

(971) 206-5209

NPI assigned

Aug 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Roberta Marie Porter Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186704000000",
    "number": "1790977072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY",
            "address_2": "SUITE 100 CONSONUS HEALTHCARE SERVICES",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "97222",
            "telephone_number": "971-206-5149",
            "fax_number": "971-206-5209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY",
            "address_2": "SUITE 100 CONSONUS HEALTHCARE SERVICES",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "97222",
            "telephone_number": "971-206-5149",
            "fax_number": "971-206-5209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELL",
        "first_name": "ROBERTA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-10",
        "last_updated": "2007-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "4966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERTA",
            "last_name": "PORTER",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Teresa Moore Niccum, PT
• James Nicholas
• Blaire M Nichols, LMT
• Rodney S. Nichols, D.M.D.
• Cora Sue Nickel, O.T.
• Russell Nickels, MD
• Jessica Nicolle
• Craig Andrew Nielsen, LCSW
• Eric F. Nielson, M.A.
• Lacey Nielson

• Occupational Therapist in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Occupational Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.