Provider Demographics
NPI:1750771150
Name:OSBERG, NICHOLAS A
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:OSBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E WALNUT AVE
Mailing Address - Street 2:CARNAHAN THERAPY
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7027
Mailing Address - Country:US
Mailing Address - Phone:805-735-3714
Mailing Address - Fax:805-736-6392
Practice Address - Street 1:805 E WALNUT AVE
Practice Address - Street 2:CARNAHAN THERAPY
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7027
Practice Address - Country:US
Practice Address - Phone:805-735-3714
Practice Address - Fax:805-736-6392
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291931225100000X
CAOT13735225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist