Provider Demographics
NPI:1659002616
Name:LECOURT, NICOLE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:LECOURT
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 1:11587 MALLORY SQUARE DR APT 304
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6298
Mailing Address - Country:US
Mailing Address - Phone:863-510-8221
Mailing Address - Fax:
Practice Address - Street 1:11587 MALLORY SQUARE DR APT 304
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6298
Practice Address - Country:US
Practice Address - Phone:863-510-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18984224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant