Provider Demographics
NPI:1760731236
Name:RAUS, NICOLE ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:RAUS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15414 N. 7TH STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022
Mailing Address - Country:US
Mailing Address - Phone:602-476-7519
Mailing Address - Fax:602-445-4971
Practice Address - Street 1:15414 N. 7TH STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-476-7519
Practice Address - Fax:602-445-4971
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5166224Z00000X
FLOTA12277224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant