Provider Demographics
NPI:1841523966
Name:WILLIAMS, NICHOLE LYNN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 E 23RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-0800
Mailing Address - Country:US
Mailing Address - Phone:186-678-4232
Mailing Address - Fax:187-755-0660
Practice Address - Street 1:1005 E 23RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-0800
Practice Address - Country:US
Practice Address - Phone:192-875-5450
Practice Address - Fax:192-875-5456
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3721225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist