Provider Demographics
NPI:1679332415
Name:TERPSTRA, NICOLE ANNE (OTR/OTD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:TERPSTRA
Suffix:
Gender:F
Credentials:OTR/OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 E MARKET ST STE 5
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-2301
Mailing Address - Country:US
Mailing Address - Phone:574-773-7733
Mailing Address - Fax:574-773-7133
Practice Address - Street 1:1309 E MARKET ST STE 5
Practice Address - Street 2:
Practice Address - City:NAPPANEE
Practice Address - State:IN
Practice Address - Zip Code:46550-2301
Practice Address - Country:US
Practice Address - Phone:574-773-7733
Practice Address - Fax:574-773-7133
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008172A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist