LESLEY NICOLOFF OTTO MD, LLC (NPI# 1417138769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417138769 |
| Entity Type | Organization |
| Organization Name | LESLEY NICOLOFF OTTO MD, LLC |
| Practice Address |
9155 Sw Barnes Rd Suite 634 Portland OR 97225-6633 |
| Practice Telephone | 5032974123 |
| Practice Fax Number | 5032970344 |
| Mailing Telephone | 5032974123 |
| Mailing Fax Number | 5032970344 |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2010-12-20 |
| Authorized Official Name | LESLEY N OTTO (PHYSICIAN) |
| Authorized Official Telephone | 5032974123 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
MD18878 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 073122 | 05 | |
| OR | MEDICAL LICENSE | MD18878 | 01 |
| Street Address |
9155 SW BARNES RD SUITE 634 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97225-6633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487657052 | Nancy Lynn Spencer | Nurse Practitioner | 9155 Sw Barnes Rd, Ste 740, Portland, OR 97225-6634 | 2005-05-27 |
| 1366918518 | Emily Secter | Occupational Therapist | 9155 Sw Barnes Rd, Portland, OR 97225 | 2018-10-15 |
| 1154806479 | Nicole Kuhl | Occupational Therapist | 9155 Sw Barnes Rd, Portland, OR 97225-6625 | 2018-10-02 |
| 1497267199 | Kolten William Paryzek | Physician Assistant | 9155 Sw Barnes Rd, Portland, OR 97225-6625 | 2017-11-02 |
| 1275077463 | Carolyn Durfee | Speech-Language Pathologist | 9155 Sw Barnes Rd, East Pavilion, Portland, OR 97225-6625 | 2016-12-07 |
| 1013466549 | Kimberly Grady | Physician Assistant | 9155 Sw Barnes Rd, Suite 321, Portland, OR 97225-6625 | 2016-09-26 |
| 1811443054 | Christie Veenkamp | Speech-Language Pathologist | 9155 Sw Barnes Rd, East Pavilion - PCdi (prov Children's Devel. Institute), Portland, OR 97225-6625 | 2016-08-28 |
| 1063967628 | Suzanne Mckenzie | Speech-Language Pathologist | 9155 Sw Barnes Rd, Portland, OR 97225-6625 | 2016-08-23 |
| 1720533516 | Amanda Margolin | Dietitian, Registered | 9155 Sw Barnes Rd, Suite 161, Portland, OR 97225-6625 | 2016-08-22 |
| 1053865592 | Ashleigh B Connell | Speech-Language Pathologist | 9155 Sw Barnes Rd, Children's Development Institute, East Pavilion, Portland, OR 97225-6625 | 2016-08-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508425034 | Gabrielle Gonzales | Behavior Technician | 1675 Sw Marlow Ave, Suite 200, Portland, OR 97225 | 2019-06-08 |
| 1558844555 | Tate Roseberry | Behavior Technician | 1675 Sw Marlow Avenue, Suite 200, Portland, OR 97225 | 2018-09-14 |
| 1982186300 | Dean Alan Hopkins | Registered Nurse | 11782 Sw Barnes Rd, Suite 300, Portland, OR 97225 | 2018-09-01 |
| 1316449168 | Surgery Center At St. Vincent, LLC | Clinic/Center | 9135 Sw Barnes Rd Ste 161, Portland, OR 97225 | 2018-03-07 |
| 1730606716 | Meghan Louise Lacy | Pediatrics | 11790 Sw Barnes Rd, Blg. A, Suite 140, Portland, OR 97225 | 2017-08-29 |
| 1841733433 | Tia Pugh | Occupational Therapist | 9155 S.w. Barnes Road, East Pavilion, Portland, OR 97225 | 2016-11-30 |
| 1295185585 | Stephanie Lynn Hart | Nurse Practitioner | 9155 Sw Barnes Rd Ste 240, Portland, OR 97225 | 2016-06-16 |
| 1962866244 | Bejian Shamloo | Chiropractor | 10200 Sw Eastridge St., Suite 235, Portland, OR 97225 | 2016-04-12 |
| 1992162630 | Robert Joseph Yoder | Psychologist | 9045 Barnes Rd, Portland, OR 97225 | 2016-01-26 |
| 1316303951 | Katie Herold | Chiropractor | 9315 Sw Morrison St, Portland, OR 97225 | 2016-01-12 |
| Find all providers in zip 97225 | ||||
| Taxonomy Code | 207VG0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780141804 | Amybrunermd LLC | Obstetrics & Gynecology | 6958 Sw Varns Street, Portland, OR 97223 | 2019-02-25 |
| 1649775610 | Asma S. Ahmad, Md, LLC | Obstetrics & Gynecology | 4160 Sw Charming Way, Portland, OR 97225-2025 | 2018-03-29 |
| 1033323613 | Laila Raad Sillay | Obstetrics & Gynecology | 9555 Sw Barnes Rd Ste 360, Portland, OR 97225-6617 | 2007-05-10 |
| 1528181625 | Emily Christina Culbert | Obstetrics & Gynecology | 4626 Se Salmon St, Portland, OR 97215-2542 | 2007-04-06 |
| 1891831558 | Margaret J Schoeller | Obstetrics & Gynecology | 1355 Congress Street, Portland, ME 04102-2148 | 2007-01-29 |
| 1922174507 | Diana E Bell | Obstetrics & Gynecology | 9427 Sw Barnes Rd Ste 599, Portland, OR 97225-6652 | 2006-11-27 |
| 1801905534 | Virginia Jane Smith | Obstetrics & Gynecology | Kaiser Permanente Interstate Medical Office East, 3550 N Interstate Ave, Portland, OR 97227-1043 | 2006-08-29 |
| 1780697177 | Richard M Wong | Obstetrics & Gynecology | 1025 Nw Couch St Apt 612, Portland, OR 97209-4130 | 2006-08-15 |
| 1952330631 | Susan Johnson, Md LLC | Obstetrics & Gynecology | 2209 Lloyd Ctr, Portland, OR 97232-1315 | 2006-07-03 |
| 1922034115 | Laura A Korman | Obstetrics & Gynecology | 2250 Nw Flanders Street, Suite 205, Portland, OR 97210-5410 | 2006-06-23 |
| Find all providers in PORTLAND | ||||
Please comment or provide details below to improve the information on LESLEY NICOLOFF OTTO MD, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.