Provider Demographics
NPI:1124525852
Name:KILIJANCZYK, NICOLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:KILIJANCZYK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:JESCHELNIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1831 W ROSE GARDEN LN STE 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 E PIMA ST STE G
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5638
Practice Address - Country:US
Practice Address - Phone:520-232-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010141225X00000X
AZOTH-009674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist