MEDICARE: NICOLE WENZEL 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
1	225X00000X	Occupational Therapist	3052	AL
2	225XP0200X	Pediatric Occupational Therapist	OTR2043	AR

General Provider Information

NPI Number	:	1578881199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WENZEL OTR/L

Provider Business Mailing Address
First Line	:	1190 SPRINGDALE
Second Line	:
City	:	HELENA
State	:	AR
Zip	:	72342-1406
Country	:	US
Telephone Number	:	870-995-2183
Fax Number	:

Provider Business Practice Location Address
First Line	:	1190 SPRINGDALE
Second Line	:
City	:	HELENA
State	:	AR
Zip	:	72342-1406
Country	:	US
Telephone Number	:	870-995-2183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	11/11/2010

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Directions to “ NICOLE WENZEL OTR/L” Practice Location

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