Provider Demographics
NPI:1770080228
Name:HAARMA, NICOLE MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:HAARMA
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 1:3456 S VALERIE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2370
Mailing Address - Country:US
Mailing Address - Phone:602-214-6263
Mailing Address - Fax:
Practice Address - Street 1:39315 N CORTONA DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-6242
Practice Address - Country:US
Practice Address - Phone:602-214-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist