Provider Demographics
NPI:1083381099
Name:HETTINGER, NICOLE RIETZ (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RIETZ
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:RIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3917 MINNEKAHTA DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3259
Mailing Address - Country:US
Mailing Address - Phone:406-670-0907
Mailing Address - Fax:
Practice Address - Street 1:412 OSHKOSH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2420
Practice Address - Country:US
Practice Address - Phone:605-716-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11372302-4201225X00000X
SD1220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist