Individual
NICOLE ELLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3900 KRUSE WAY PL, LAKE OSWEGO, OR 97035-2512
(503) 607-0566
Mailing address
23532 SW STONEHAVEN ST, SHERWOOD, OR 97140-7076
(971) 732-2991
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1060547
OR
Other
Enumeration date
06/02/2008
Last updated
05/06/2022
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