Provider Demographics
NPI:1750686556
Name:GREGORY, NICOLE LANCASTER (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LANCASTER
Last Name:GREGORY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:350 VISTA COURT DRIVE APT 2304
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:945-271-5026
Mailing Address - Fax:903-535-7384
Practice Address - Street 1:350 VISTA COURT DRIVE APT 2304
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074
Practice Address - Country:US
Practice Address - Phone:945-271-5026
Practice Address - Fax:903-535-7384
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist