Provider Demographics
NPI:1407508120
Name:D'ESPOSITO, NICOLETTE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:D'ESPOSITO
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 REDWOOD BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-4135
Mailing Address - Country:US
Mailing Address - Phone:818-689-3588
Mailing Address - Fax:
Practice Address - Street 1:500 TAMAL PLZ STE 525
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1178
Practice Address - Country:US
Practice Address - Phone:415-531-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist