Provider Demographics
NPI:1578801783
Name:DADDIO, NICOLE DEANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:DEANNE
Last Name:DADDIO
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 1:13780 DEL CORSO WAY APT 1523
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-8414
Mailing Address - Country:US
Mailing Address - Phone:757-375-0512
Mailing Address - Fax:
Practice Address - Street 1:1531 EUDORA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1248
Practice Address - Country:US
Practice Address - Phone:757-375-0512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-19-78623106S00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician