Provider Demographics
NPI:1831653575
Name:SUNNY, NIKITA (OTR/L)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:SUNNY
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 1:1567 FLYNN RD APT 7211
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5829
Mailing Address - Country:US
Mailing Address - Phone:813-573-4491
Mailing Address - Fax:
Practice Address - Street 1:205 GRANADA ST
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7715
Practice Address - Country:US
Practice Address - Phone:805-482-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT18051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist