Provider Demographics
NPI:1093461162
Name:KAMERMAN, NICOLE TAYLOR (MOT/R)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:TAYLOR
Last Name:KAMERMAN
Suffix:
Gender:F
Credentials:MOT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 MANCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4756
Mailing Address - Country:US
Mailing Address - Phone:208-360-4584
Mailing Address - Fax:
Practice Address - Street 1:3814 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7591
Practice Address - Country:US
Practice Address - Phone:208-360-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist