Provider Demographics
NPI:1629608161
Name:AURORA, NICHOLAS GEORGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:AURORA
Suffix:
Gender:M
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 1:309 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-6858
Mailing Address - Country:US
Mailing Address - Phone:401-849-3204
Mailing Address - Fax:
Practice Address - Street 1:309 SPRING ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-6858
Practice Address - Country:US
Practice Address - Phone:401-849-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOT01513OtherOTR