Provider Demographics
NPI:1821220088
Name:SCHULTZ, NINA TONI (OTR/L)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:TONI
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANTONINA
Other - Middle Name:
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2560 N TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2560 N TEXAS ST
Practice Address - Street 2:STE. D
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1649
Practice Address - Country:US
Practice Address - Phone:707-330-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist