Individual
NICOLE ALISON FUKUZAWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4202 N 20TH AVE, PHOENIX, AZ 85015-5101
(714) 642-7543
Mailing address
28515 N NORTH VALLEY PKWY APT 2097, PHOENIX, AZ 85085-5416
(714) 642-7543
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
AZ
Other
Enumeration date
10/16/2020
Last updated
10/16/2020
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