Individual
NICHOLETTA FORTUNATO-TAMAYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1828 E FLORENCE BLVD, CASA GRANDE, AZ 85122-4783
(520) 381-6300
Mailing address
1450 S COLT DR, GILBERT, AZ 85296-7344
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTH-007625
AZ
Other
Enumeration date
02/20/2019
Last updated
02/20/2019
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