Provider Demographics
NPI:1083768931
Name:SKODIAK, NANCY CAROL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CAROL
Last Name:SKODIAK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:CAROL
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48 W SUFFOLK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7139
Mailing Address - Country:US
Mailing Address - Phone:520-575-6215
Mailing Address - Fax:
Practice Address - Street 1:11279 W GRIER RD
Practice Address - Street 2:MUSD SPECIAL EDUCATION
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-9609
Practice Address - Country:US
Practice Address - Phone:520-682-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1457225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist