MEDICARE: KELLY A NESBITT OTR/L, CAPS, ECHM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XG0600X	Gerontology Occupational Therapist	1036721	OR

General Provider Information

NPI Number	:	1508193830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A NESBITT OTR/L, CAPS, ECHM

Provider Business Mailing Address
First Line	:	8564 N RICHMOND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203
Country	:	US
Telephone Number	:	503-673-6299
Fax Number	:

Provider Business Practice Location Address
First Line	:	8564 N RICHMOND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97203
Country	:	US
Telephone Number	:	503-673-6299
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	01/13/2026

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