MEDICARE: NICOLE E PAPUZZA 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	118810	TX
2	225X00000X	Occupational Therapist	18249	CA
3	225X00000X	Occupational Therapist	7293	AZ
4	225X00000X	Occupational Therapist	0119008513	VA

General Provider Information

NPI Number	:	1639666183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE E PAPUZZA OTR/L

Provider Business Mailing Address
First Line	:	25256 MCINTYRE SQ
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-3967
Country	:	US
Telephone Number	:	518-894-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	9150 W INDIAN SCHOOL RD STE 105
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-2385
Country	:	US
Telephone Number	:	623-500-2409
Fax Number	:

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

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	04/08/2020

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