Provider Demographics
NPI:1275679284
Name:HENGST, NIKKI LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:HENGST
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N 12TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1242
Mailing Address - Country:US
Mailing Address - Phone:717-737-9818
Mailing Address - Fax:717-737-2815
Practice Address - Street 1:550 N 12TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1242
Practice Address - Country:US
Practice Address - Phone:717-737-9818
Practice Address - Fax:717-737-2815
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP005906224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOP005906OtherCOTA LIC NBR