Individual
NICOLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
17415 N 92ND AVE, PEORIA, AZ 85382-8214
(480) 252-5337
Mailing address
17415 N 92ND AVE, PEORIA, AZ 85382-8214
(480) 252-5337
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7031
AZ
Other
Enumeration date
04/05/2018
Last updated
04/05/2018
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