Provider Demographics
NPI:1154668960
Name:ZONANA, NICOLE C (OT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:ZONANA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:C
Other - Last Name:POVEROMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:209 CASTLEWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5163
Mailing Address - Country:US
Mailing Address - Phone:615-898-7461
Mailing Address - Fax:615-898-7490
Practice Address - Street 1:209 CASTLEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5163
Practice Address - Country:US
Practice Address - Phone:615-898-7461
Practice Address - Fax:615-898-7490
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT37777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist