Individual
NICOLE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
551 S HIGLEY RD, MESA, AZ 85206-2148
(480) 892-9777
(480) 635-0222
Mailing address
551 S HIGLEY RD, MESA, AZ 85206-2148
(480) 892-9777
(480) 635-0222
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
02/16/2017
Last updated
02/17/2017
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