Provider Demographics
NPI:1043306996
Name:KAIN, NICHOLE MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:MARIE
Last Name:KAIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MARIE
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:PO BOX 2162
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80502-2162
Mailing Address - Country:US
Mailing Address - Phone:720-295-1607
Mailing Address - Fax:
Practice Address - Street 1:2350 LIMON DR
Practice Address - Street 2:COVELL CARE
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:720-295-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist