Provider Demographics
NPI:1700250024
Name:NICKEL, AMY KATHERINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:NICKEL
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 1:2204 VALLEYHIGH DR NW # APTD208
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7401
Mailing Address - Country:US
Mailing Address - Phone:651-955-6220
Mailing Address - Fax:
Practice Address - Street 1:2204 VALLEYHIGH DR NW # APTD208
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-7401
Practice Address - Country:US
Practice Address - Phone:651-955-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist