Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1025941 | CO |
NPI | 1003047572 |
---|---|
Provider Name | Mrs. Nickie Dee Ann Rico |
First Address | Westminster, CO 80234-3789 |
Second Address | Westminster, CO 80234-3789 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2009 |
Last Update Date | 01/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71657754 | (05) | CO |