Provider Demographics
NPI:1295006005
Name:WILLMAN, NIKOLE M (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:M
Last Name:WILLMAN
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 1:172 FLATWATER DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9348
Mailing Address - Country:US
Mailing Address - Phone:631-897-7038
Mailing Address - Fax:
Practice Address - Street 1:172 FLATWATER DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9348
Practice Address - Country:US
Practice Address - Phone:631-897-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009896-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist