Provider Demographics
NPI:1235544354
Name:REAVES, NICOLE (MS, OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:REAVES
Suffix:
Gender:F
Credentials:MS, OTR/L, CHT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LOKIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR STE 213
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7503
Mailing Address - Country:US
Mailing Address - Phone:949-644-1322
Mailing Address - Fax:
Practice Address - Street 1:5630 E SANTA ANA CANYON RD STE 105
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-282-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14414225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist