Provider Demographics
NPI:1346725538
Name:PRYOR, NICOLE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:PRYOR
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 1:9630 MILESTONE WAY APT 3115
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4348
Mailing Address - Country:US
Mailing Address - Phone:313-522-6594
Mailing Address - Fax:
Practice Address - Street 1:1200 FIRST ST NE
Practice Address - Street 2:9TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:313-522-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19170225X00000X
DCOT010000351225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist