Provider Demographics
NPI:1326630542
Name:MCMAHON, NICOLE (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 SILVER GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2475
Mailing Address - Country:US
Mailing Address - Phone:414-870-6072
Mailing Address - Fax:
Practice Address - Street 1:215 E NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6403
Practice Address - Country:US
Practice Address - Phone:407-898-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21618225X00000X
NC1346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist