Provider Demographics
NPI:1659585503
Name:COVATI, NICOLE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:COVATI
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 1:320 LAURA FAYE LN
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1345
Mailing Address - Country:US
Mailing Address - Phone:845-558-8011
Mailing Address - Fax:
Practice Address - Street 1:100 SUMMIT HILLS DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1532
Practice Address - Country:US
Practice Address - Phone:864-342-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3513225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ352849128Medicare PIN