Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 116021 | TX |
N | 225X00000X | Occupational Therapist | 296732 | OR |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 6447 | AZ |
NPI | 1053669812 |
---|---|
Provider Name | Ms. Nicole Ashley Rambeau |
First Address | Flagstaff, AZ 86004-1957 |
Second Address | Flagstaff, AZ 86004-1957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 19/02/2016 |