Healthcare Provider Details

I. General information

NPI: 1063002608
Provider Name (Legal Business Name): PAIGE MARIE NELLES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20288 HIGHWAY 15 N STE 100
HUTCHINSON MN
55350-5685
US

IV. Provider business mailing address

1536 JAMISON AVE NE
SAINT MICHAEL MN
55376-9363
US

V. Phone/Fax

Practice location:
  • Phone: 320-587-2326
  • Fax:
Mailing address:
  • Phone: 763-229-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number106424
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: