Healthcare Provider Details

I. General information

NPI: 1053145839
Provider Name (Legal Business Name): CHELSIE NICK OTR/L,CSRS,CNS,CBIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 E 91ST ST
TULSA OK
74133-5835
US

IV. Provider business mailing address

7418 E 125TH ST S
BIXBY OK
74008-2673
US

V. Phone/Fax

Practice location:
  • Phone: 918-940-8801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number1919
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: