Provider Demographics
NPI:1518032358
Name:MCANARY, NICOLE JENELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JENELLE
Last Name:MCANARY
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 1:5205 WATERMILL LN APT 106
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7837
Mailing Address - Country:US
Mailing Address - Phone:305-303-3792
Mailing Address - Fax:321-268-5698
Practice Address - Street 1:1220 PROSPECT ROAD
Practice Address - Street 2:#292
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:305-303-3792
Practice Address - Fax:321-268-5698
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10296225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist