Provider Demographics
NPI:1639666183
Name:PAPUZZA, NICOLE E (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:PAPUZZA
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 1:25256 MCINTYRE SQ
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-3967
Mailing Address - Country:US
Mailing Address - Phone:518-894-3344
Mailing Address - Fax:
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2385
Practice Address - Country:US
Practice Address - Phone:623-500-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118810225X00000X
CA18249225X00000X
AZ7293225X00000X
VA0119008513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist