Provider Demographics
NPI:1639556046
Name:CHAVES, NICHOLE DENNISE (COTA/L)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:DENNISE
Last Name:CHAVES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4181 MEDFORD DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4517
Mailing Address - Country:US
Mailing Address - Phone:704-788-4461
Mailing Address - Fax:
Practice Address - Street 1:4181 MEDFORD DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4517
Practice Address - Country:US
Practice Address - Phone:704-788-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8332224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant