Provider Demographics
NPI:1003148594
Name:NUCKOLS, KRISTIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:NUCKOLS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CANAL ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4589
Mailing Address - Country:US
Mailing Address - Phone:617-682-0843
Mailing Address - Fax:617-250-8243
Practice Address - Street 1:110 CANAL ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4589
Practice Address - Country:US
Practice Address - Phone:617-671-0789
Practice Address - Fax:617-250-8243
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12544225XN1300X
VA0119004751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation