MEDICARE: NICHOLAS DAVID SCHULZ 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
2	225X00000X	Occupational Therapist	1796	ND

General Provider Information

NPI Number	:	1891274890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS DAVID SCHULZ OTR/L

Provider Business Mailing Address
First Line	:	5514 LORI LN W
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8557
Country	:	US
Telephone Number	:	218-252-2628
Fax Number	:

Provider Business Practice Location Address
First Line	:	5514 LORI LN W
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8557
Country	:	US
Telephone Number	:	218-252-2628
Fax Number	:

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	01/14/2024

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