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General NPI Number Information
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NPI Number | 1174839344
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Entity Type | Individual
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Provider Name | MICHELLE RENEE NELSON C.O.T.A
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Gender | Female
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 4525 W TULARE AVE
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City | VISALIA
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State | CA
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Zip | 93277-1560
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Country | US
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Telephone | 530-781-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 19601 CHEROKEE ROAD P.O. BOX 435
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City | TUOLUMNE
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State | CA
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Zip | 95379-0435
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Country | US
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Telephone | 209-928-9248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OTA-689
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License Number State | CA
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