Provider Demographics
NPI:1639648173
Name:FECTEAU, NICOLE MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:FECTEAU
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 WEIR RD
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-9484
Mailing Address - Country:US
Mailing Address - Phone:989-724-8037
Mailing Address - Fax:
Practice Address - Street 1:1663 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2169
Practice Address - Country:US
Practice Address - Phone:248-327-6619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009908225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist