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Individual

NICOLE R ENSLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1720 ALBER ST, WABASH, IN 46992-1015
(260) 563-4112
Mailing address
746 WOODLAWN ST, HUNTINGTON, IN 46750-2352
(260) 388-4005

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002933A
IN
224Z00000X
Occupational Therapy Assistant
32002933A

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
32002933A
INDIVIDUAL
Enumeration date
10/31/2022
Last updated
10/31/2022
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