Individual
NICOLE NILSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
409 MISSION VILLAS RD, SAN MARCOS, CA 92069-2076
(970) 380-0984
Mailing address
409 MISSION VILLAS RD, SAN MARCOS, CA 92069-2076
(970) 380-0984
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2728
CA
Other
Enumeration date
10/07/2025
Last updated
10/07/2025
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