Provider Demographics
NPI:1669664405
Name:ROD, NICOLE MARIE (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:ROD
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7753 CORIANDER PL
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-8037
Mailing Address - Country:US
Mailing Address - Phone:248-202-4887
Mailing Address - Fax:
Practice Address - Street 1:7753 CORIANDER PL
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-8037
Practice Address - Country:US
Practice Address - Phone:248-202-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist