Individual
NICOLE KERTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
173 DRURY CT, BLOOMSDALE, MO 63627-8100
(573) 880-3885
Mailing address
173 DRURY CT, BLOOMSDALE, MO 63627-8100
(573) 880-3885
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07171997
—
MO
Enumeration date
05/13/2021
Last updated
05/11/2026
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