Provider Demographics
NPI:1356998801
Name:KISSMANN, NICOLE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KISSMANN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40936 W THORNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-6572
Mailing Address - Country:US
Mailing Address - Phone:714-423-7791
Mailing Address - Fax:
Practice Address - Street 1:40936 W THORNBERRY LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-6572
Practice Address - Country:US
Practice Address - Phone:714-423-7791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist