Provider Demographics
NPI:1013046036
Name:CARDILLO, NICOLE MARY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARY
Last Name:CARDILLO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:MARY
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:209 E LUZERNE AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1036
Mailing Address - Country:US
Mailing Address - Phone:570-288-7386
Mailing Address - Fax:
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1620
Practice Address - Country:US
Practice Address - Phone:570-307-1769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist