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General NPI Number Information
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NPI Number | 1629525027
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Entity Type | Individual
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Provider Name | TAMI NELSON
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Gender | Female
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 422 3RD ST W 135
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City | ASHLAND
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State | WI
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Zip | 54806-1553
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Country | US
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Telephone | 715-682-0633
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Fax |
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Provider Business Mailing Address
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Address Line | 7665 US HIGHWAY 2
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City | IRON RIVER
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State | WI
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Zip | 54847-4690
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Country | US
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Telephone | 715-372-5001
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 5923
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License Number State | WI
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