Provider Demographics
NPI:1578725289
Name:RADOMICKI, NANCY E (OTA/L)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:RADOMICKI
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 ANGEL DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2525
Mailing Address - Country:US
Mailing Address - Phone:302-994-8338
Mailing Address - Fax:
Practice Address - Street 1:2309 ANGEL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2525
Practice Address - Country:US
Practice Address - Phone:302-994-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU2-000013A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant