Provider Demographics
NPI:1528248358
Name:NORDBECK, NANCY ANNE (COTA)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANNE
Last Name:NORDBECK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53952-9671
Mailing Address - Country:US
Mailing Address - Phone:608-586-5237
Mailing Address - Fax:
Practice Address - Street 1:300 RACE ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-1822
Practice Address - Country:US
Practice Address - Phone:608-254-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI210-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant