Provider Demographics
NPI:1679098560
Name:WINTHER, NICOLEILA (OTR)
Entity type:Individual
Prefix:
First Name:NICOLEILA
Middle Name:
Last Name:WINTHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18245 N PIMA RD APT 3053
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6374
Mailing Address - Country:US
Mailing Address - Phone:623-282-5628
Mailing Address - Fax:
Practice Address - Street 1:18245 N PIMA RD APT 3053
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6374
Practice Address - Country:US
Practice Address - Phone:623-282-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist