Healthcare Provider Details

I. General information

NPI: 1841963220
Provider Name (Legal Business Name): NICOLE CAPILLE COLVIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE CAPILLE OTR/L

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4090
US

IV. Provider business mailing address

2250 N DENVER PL
TULSA OK
74106-3629
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-1000
  • Fax:
Mailing address:
  • Phone: 352-875-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT19405
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number5285
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5285
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: