Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 5669 | AZ |
Y | 224Z00000X | Occupational Therapy Assistant | OT-A962 | AR |
NPI | 1003214982 |
---|---|
Provider Name | Mrs. Nicole Claire Wilson |
First Address | Little Rock, AR 72227-3029 |
Second Address | Little Rock, AR 72227-3029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2014 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207699721 | (05) | AR |