Provider Demographics
NPI:1558483933
Name:DRAKE, NICOLE MARINA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARINA
Last Name:DRAKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:MARINA
Other - Last Name:MORDRET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:414 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-1523
Mailing Address - Country:US
Mailing Address - Phone:714-488-9081
Mailing Address - Fax:
Practice Address - Street 1:414 N 2ND ST
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-1523
Practice Address - Country:US
Practice Address - Phone:714-488-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6645225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist