Individual
BENJAMIN NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3150 N WINDING BROOK RD, FLAGSTAFF, AZ 86001-0972
(928) 774-7106
Mailing address
19 S SAN FRANCISCO ST, FLAGSTAFF, AZ 86001-5736
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5342
AZ
Other
Enumeration date
08/02/2013
Last updated
08/02/2013
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