Provider Demographics
NPI:1891166237
Name:DAVIS, NICOLE EZELL (MSOTR/L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:EZELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 694
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0694
Mailing Address - Country:US
Mailing Address - Phone:360-301-2316
Mailing Address - Fax:
Practice Address - Street 1:839 WHITERIVER AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3515
Practice Address - Country:US
Practice Address - Phone:970-665-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008860225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist