Provider Demographics
NPI:1376689307
Name:SIGONA, NICOLE RENEE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RENEE
Last Name:SIGONA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11723 HOLLYCREST DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1325
Mailing Address - Country:US
Mailing Address - Phone:314-518-4674
Mailing Address - Fax:
Practice Address - Street 1:11723 HOLLYCREST DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1325
Practice Address - Country:US
Practice Address - Phone:314-518-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000175623225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1114090792OtherGROUP NPI
MO479008500Medicaid
MO507265809Medicaid
MO000014441Medicare ID - Type UnspecifiedSENSORY SOLUTIONS GROUP #