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General NPI Number Information
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NPI Number | 1891166237
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Entity Type | Individual
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Provider Name | NICOLE EZELL DAVIS M.S.OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 09/28/2025
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Provider Practice Location Address
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Address Line | 839 WHITERIVER AVE
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City | RIFLE
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State | CO
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Zip | 81650-3515
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Country | US
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Telephone | 970-665-7600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 694
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81602-0694
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Country | US
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Telephone | 360-301-2316
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0008860
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License Number State | CO
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