Provider Demographics
NPI:1659853299
Name:LUX, NICOLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:LUX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BALTHAZOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1784 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3630
Mailing Address - Country:US
Mailing Address - Phone:925-548-8874
Mailing Address - Fax:
Practice Address - Street 1:705 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3014
Practice Address - Country:US
Practice Address - Phone:707-255-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist