Provider Demographics
NPI:1952827248
Name:NEILSON, SUNDAE NICHOLE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:SUNDAE
Middle Name:NICHOLE
Last Name:NEILSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15704 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9724
Mailing Address - Country:US
Mailing Address - Phone:567-356-6171
Mailing Address - Fax:
Practice Address - Street 1:524 JAMES WAY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7801
Practice Address - Country:US
Practice Address - Phone:740-389-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008385225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation