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NPI Code Detail

MEDICARE: NICOLE HARLEY OTR/L

MEDICARE: NICOLE HARLEY OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist4854AZ

General Provider Information

NPI Number : 1427346345
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE HARLEY OTR/L
Provider Business Mailing Address
First Line : 809 W GROVE PKWY APT 2104
Second Line :
City : TEMPE
State : AZ
Zip : 85283-8449
Country : US
Telephone Number : 425-984-4394
Fax Number :
Provider Business Practice Location Address
First Line : 1190 E MISSOURI AVE STE 100
Second Line :
City : PHOENIX
State : AZ
Zip : 85014-2719
Country : US
Telephone Number : 602-393-0520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2011
Last Update Date : 07/12/2011

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Directions to “ NICOLE HARLEY OTR/L” Practice Location

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