Provider Demographics
NPI:1053063891
Name:PEURA, NICOLE ALISE (OTR)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALISE
Last Name:PEURA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 WETHERSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1711
Mailing Address - Country:US
Mailing Address - Phone:978-360-4238
Mailing Address - Fax:
Practice Address - Street 1:20 GRAF RD SUITE # 101
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950
Practice Address - Country:US
Practice Address - Phone:978-358-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13804225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist