Provider Demographics
NPI:1851929319
Name:LOTT, NICOLE PECCHIO (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:PECCHIO
Last Name:LOTT
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FLEETWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3204
Mailing Address - Country:US
Mailing Address - Phone:475-218-6200
Mailing Address - Fax:
Practice Address - Street 1:300 FEDERAL RD STE 210
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2412
Practice Address - Country:US
Practice Address - Phone:475-218-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty