Provider Demographics
NPI:1336511997
Name:ALVAREZ, NICOLE AMBER (OTR)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMBER
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-0095
Mailing Address - Country:US
Mailing Address - Phone:651-267-5469
Mailing Address - Fax:651-267-5946
Practice Address - Street 1:701 HEWITT BLVD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2848
Practice Address - Country:US
Practice Address - Phone:651-267-5469
Practice Address - Fax:651-267-5946
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist