Provider Demographics
NPI:1376242669
Name:PARKER, NICHOLAS (COTA/L)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MARCIA RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1833
Mailing Address - Country:US
Mailing Address - Phone:973-934-8329
Mailing Address - Fax:
Practice Address - Street 1:540 W HANOVER AVE
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2152
Practice Address - Country:US
Practice Address - Phone:973-607-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09237400224Z00000X
NY011297224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011297OtherNEW YORK STATE EDUCATION DEPARTMENT
NJ46TA09237400OtherNJ DIVISION OF CONSUMER AFFAIRS