Provider Demographics
NPI:1477995439
Name:SHIVACK, NADIA E (OTR/L)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:E
Last Name:SHIVACK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N SILVERBELL RD APT 89
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2646
Mailing Address - Country:US
Mailing Address - Phone:520-792-2592
Mailing Address - Fax:
Practice Address - Street 1:350 N SILVERBELL RD APT 89
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2646
Practice Address - Country:US
Practice Address - Phone:520-792-2592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist