Healthcare Provider Details

I. General information

NPI: 1457557266
Provider Name (Legal Business Name): CHELSEY NICHOLSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 11/01/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 N 160TH AVE
SURPRISE AZ
85374-5708
US

IV. Provider business mailing address

16250 N 160TH AVE
SURPRISE AZ
85374-5708
US

V. Phone/Fax

Practice location:
  • Phone: 309-261-0263
  • Fax:
Mailing address:
  • Phone: 309-261-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3291
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009333
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: