Provider Demographics
NPI:1801392592
Name:MANCUSI, NICOLETTE MICHELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLETTE
Middle Name:MICHELLE
Last Name:MANCUSI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 MCLEAN AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4690
Mailing Address - Country:US
Mailing Address - Phone:203-947-1024
Mailing Address - Fax:
Practice Address - Street 1:479 MCLEAN AVE APT 2A
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4690
Practice Address - Country:US
Practice Address - Phone:203-947-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant