Provider Demographics
NPI:1679734602
Name:COZEAN, NICOLE (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:COZEAN
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 INDEPENDENCE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5025
Mailing Address - Country:US
Mailing Address - Phone:573-335-7868
Mailing Address - Fax:573-335-8193
Practice Address - Street 1:2917 INDEPENDENCE ST STE 400
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5025
Practice Address - Country:US
Practice Address - Phone:573-335-7868
Practice Address - Fax:573-335-8193
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1061101220225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014981Medicare PIN