Provider Demographics
NPI:1629223615
Name:NICALEK, JADWIGA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JADWIGA
Middle Name:
Last Name:NICALEK
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 1:140 AMHERST RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3339
Mailing Address - Country:US
Mailing Address - Phone:516-808-4003
Mailing Address - Fax:
Practice Address - Street 1:140 AMHERST RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3339
Practice Address - Country:US
Practice Address - Phone:516-808-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist