Provider Demographics
NPI:1851774871
Name:NELSON, ELLEN GERALYN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:GERALYN
Last Name:NELSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14065 LEROY CENTER RD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8896
Mailing Address - Country:US
Mailing Address - Phone:440-254-1210
Mailing Address - Fax:
Practice Address - Street 1:70 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1616
Practice Address - Country:US
Practice Address - Phone:440-357-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.00631224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant