Provider Demographics
NPI:1639922503
Name:VERNICK, NICOLE J (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:VERNICK
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 1:1458 SCHIRRA DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4030
Mailing Address - Country:US
Mailing Address - Phone:215-375-5796
Mailing Address - Fax:
Practice Address - Street 1:8380 MOHR LN
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-1918
Practice Address - Country:US
Practice Address - Phone:610-285-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC19558225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics