Provider Demographics
NPI:1174187330
Name:ZACCHIO, NICOLE (MS, OTR)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:ZACCHIO
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 COUNTY ROUTE 41
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:12431-6020
Mailing Address - Country:US
Mailing Address - Phone:518-729-7141
Mailing Address - Fax:
Practice Address - Street 1:137 VIOLA ST
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4414
Practice Address - Country:US
Practice Address - Phone:845-895-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023471-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist