Caleb Glen Nicoll, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OTH-009425 Issued in AZ

Practice address

5048 E Oak St
Phoenix, AZ 85008-2522

Phone

(602) 629-6800

NPI assigned

Nov 29, 2023

Last updated

Nov 29, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1164298246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1762 E HERMOSA VISTA DR",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852032120",
            "telephone_number": "480-577-9493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5048 E OAK ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850082522",
            "telephone_number": "602-629-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLL",
        "first_name": "CALEB",
        "middle_name": "GLEN",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-29",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "AZ",
            "license": "OTH-009425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyrie Jae Nicolds, PA-C
• Nicole Lazorwitz PSYD LLC
• Nicolex LLC (Moon Valley Eyecare)
• Nicolex LLC Dba Moon Valley Eyecare
• Brigham Nicoll
• Kevin Nicoll, MD
• Angie Nicolucci
• Heidi Marie Nida-Huff, FNP-C
• Nidaa LLC (Nidaa Behavioral Health)
• Linda Lee Nieb

• Pediatric Occupational Therapist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Pediatric Occupational Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.