Provider Demographics
NPI:1063002608
Name:NELLES, PAIGE MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MARIE
Last Name:NELLES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 JAMISON AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9363
Mailing Address - Country:US
Mailing Address - Phone:763-229-0915
Mailing Address - Fax:
Practice Address - Street 1:20288 HIGHWAY 15 N STE 100
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-5685
Practice Address - Country:US
Practice Address - Phone:320-587-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106424225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics