Provider Demographics
NPI:1235227034
Name:ANDERSON, NIKKOL KRAMER (OT)
Entity Type:Individual
Prefix:
First Name:NIKKOL
Middle Name:KRAMER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NIKKOL
Other - Middle Name:
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 5630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011-0165
Mailing Address - Country:US
Mailing Address - Phone:928-523-4628
Mailing Address - Fax:855-819-0087
Practice Address - Street 1:912 RIORDAN RANCH ROAD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011-3258
Practice Address - Country:US
Practice Address - Phone:928-380-8519
Practice Address - Fax:855-819-0087
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2198174400000X
235Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468555OtherAHCCCS NUMBER