Provider Demographics
NPI:1477295129
Name:NORDWICK, STEVEN CRAIG (CTRS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CRAIG
Last Name:NORDWICK
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-5545
Mailing Address - Country:US
Mailing Address - Phone:307-359-0234
Mailing Address - Fax:
Practice Address - Street 1:225 S PARK ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5545
Practice Address - Country:US
Practice Address - Phone:307-359-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
66526225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty