Provider Demographics
NPI:1376747907
Name:BROWN, NICOLE ANN (OTR, NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR, NP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:LEVESQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:82 BLUEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1204
Mailing Address - Country:US
Mailing Address - Phone:781-879-0917
Mailing Address - Fax:
Practice Address - Street 1:10 HARBOR ST STE 1
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3390
Practice Address - Country:US
Practice Address - Phone:978-741-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2312063363LF0000X
MA8974225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1074190OtherUS OT REGISTRATION
MA8974OtherOT LICENSE
MALE Y69578Medicare ID - Type UnspecifiedMEDICARE B