Provider Demographics
NPI:1578708988
Name:ZWIEP, NICOLE (OT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ZWIEP
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RUSSELL ST
Mailing Address - Street 2:APT 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1314
Mailing Address - Country:US
Mailing Address - Phone:508-733-3403
Mailing Address - Fax:
Practice Address - Street 1:340 TURNPIKE ST
Practice Address - Street 2:SUITE 1-3A
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2700
Practice Address - Country:US
Practice Address - Phone:781-619-1500
Practice Address - Fax:781-619-1500
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA09749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist