Provider Demographics
NPI:1346658846
Name:CARMO, NICOLE LYN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYN
Last Name:CARMO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LYN
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:127 BROOKLAWN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-5630
Mailing Address - Country:US
Mailing Address - Phone:508-958-9567
Mailing Address - Fax:
Practice Address - Street 1:127 BROOKLAWN ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-5630
Practice Address - Country:US
Practice Address - Phone:508-958-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3102224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant