Provider Demographics
NPI:1164026357
Name:FITTS, NICOLE RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:FITTS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 GREENLEAF DR
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-1373
Mailing Address - Country:US
Mailing Address - Phone:215-630-4030
Mailing Address - Fax:
Practice Address - Street 1:94 RICHBORO RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1538
Practice Address - Country:US
Practice Address - Phone:215-968-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty