Individual
CALEB GLEN NICOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
5048 E OAK ST, PHOENIX, AZ 85008-2522
(602) 629-6800
Mailing address
1762 E HERMOSA VISTA DR, MESA, AZ 85203-2120
(480) 577-9493
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTH-009425
AZ
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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