Provider Demographics
NPI:1265523617
Name:STAFFORD, NIKKI S (OT)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:S
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:S
Other - Last Name:VOGELZANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:123 MILLPORT CIRCLE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:28607-5526
Mailing Address - Country:US
Mailing Address - Phone:704-831-5050
Mailing Address - Fax:704-831-5055
Practice Address - Street 1:123 MILLPORT CIRCLE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:28607-5526
Practice Address - Country:US
Practice Address - Phone:704-831-5050
Practice Address - Fax:704-831-5055
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2655225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist