Individual
NICOLE RENE WELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12276 SAN JOSE BLVD, JACKSONVILLE, FL 32223-8628
(904) 886-3228
Mailing address
277 ROYAL LAKE DR, PONTE VEDRA, FL 32081-0509
(803) 431-6210
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA19790
FL
Other
Enumeration date
03/15/2024
Last updated
03/15/2024
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