Provider Demographics
NPI:1700357605
Name:VENTURA, NIKKI MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:MARIE
Last Name:VENTURA
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 1:3352 VALLEY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6124
Mailing Address - Country:US
Mailing Address - Phone:406-360-9138
Mailing Address - Fax:
Practice Address - Street 1:640 ENTERPRISE DR STE C
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9440
Practice Address - Country:US
Practice Address - Phone:614-433-0132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010364225X00000X
OHOT010325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist