Provider Demographics
NPI:1194044578
Name:DACRES, NICOLE ANTOINETTE
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANTOINETTE
Last Name:DACRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DILLON CT
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3502
Mailing Address - Country:US
Mailing Address - Phone:201-961-4754
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3018
Practice Address - Country:US
Practice Address - Phone:845-454-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007189224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant