Provider Demographics
NPI:1114219128
Name:NCIM INC.
Entity Type:Organization
Organization Name:NCIM INC.
Other - Org Name:COMPASSION REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NATHALIE
Authorized Official - Middle Name:BRADSHAW
Authorized Official - Last Name:CHILDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:239-878-7646
Mailing Address - Street 1:1352 SHEFFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2222
Mailing Address - Country:US
Mailing Address - Phone:239-878-7646
Mailing Address - Fax:
Practice Address - Street 1:1352 SHEFFIELD WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-2222
Practice Address - Country:US
Practice Address - Phone:239-878-7646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5879225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty