Provider Demographics
NPI:1215104237
Name:PACKER, NIKKI A (MS,OT/L)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:A
Last Name:PACKER
Suffix:
Gender:
Credentials:MS,OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6362 APPERSON DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-0116
Mailing Address - Country:US
Mailing Address - Phone:317-709-1514
Mailing Address - Fax:
Practice Address - Street 1:2800 S DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6403
Practice Address - Country:US
Practice Address - Phone:765-455-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004541A225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics