Provider Demographics
NPI:1689261190
Name:NEVELLS LLC
Entity Type:Organization
Organization Name:NEVELLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVELLS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:907-441-8817
Mailing Address - Street 1:PO BOX 670117
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0117
Mailing Address - Country:US
Mailing Address - Phone:907-441-8817
Mailing Address - Fax:933-370-0295
Practice Address - Street 1:19436 KULLBERG DR
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-6381
Practice Address - Country:US
Practice Address - Phone:907-441-8817
Practice Address - Fax:833-370-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1700188588Medicaid