Provider Demographics
NPI:1730675794
Name:NELLIS-ENGLER, CLAUDEEN MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDEEN
Middle Name:MARIE
Last Name:NELLIS-ENGLER
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 1:5536 N RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1148
Mailing Address - Country:US
Mailing Address - Phone:563-343-5311
Mailing Address - Fax:
Practice Address - Street 1:6701 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3203
Practice Address - Country:US
Practice Address - Phone:563-324-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01290225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist