Provider Demographics
NPI:1558793869
Name:WOLLASTON-LEWERS, NADINE PATRICIA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:PATRICIA
Last Name:WOLLASTON-LEWERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5919 NW BATCHELOR TER
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3602
Mailing Address - Country:US
Mailing Address - Phone:954-439-5374
Mailing Address - Fax:
Practice Address - Street 1:5919 NW BATCHELOR TER
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3602
Practice Address - Country:US
Practice Address - Phone:954-439-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist