Provider Demographics
NPI:1073893129
Name:MESSICK, NICOLE LOUISE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LOUISE
Last Name:MESSICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1211
Mailing Address - Country:US
Mailing Address - Phone:201-497-6211
Mailing Address - Fax:201-497-6212
Practice Address - Street 1:99 KINDERKAMACK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3012
Practice Address - Country:US
Practice Address - Phone:201-497-6211
Practice Address - Fax:201-497-6212
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09070400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist