Individual
NICOLE WITTROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
845 LAKE ST, ROCKWELL CITY, IA 50579-1222
(712) 790-9526
Mailing address
845 LAKE ST, ROCKWELL CITY, IA 50579-1222
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000870
IA
Other
Enumeration date
10/01/2014
Last updated
10/01/2014
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