Provider Demographics
NPI:1861836876
Name:GAY, NICOLA SIMONE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:SIMONE
Last Name:GAY
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 1:551 HUNTINGTON PL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4125
Mailing Address - Country:US
Mailing Address - Phone:954-701-5479
Mailing Address - Fax:
Practice Address - Street 1:551 HUNTINGTON PL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4125
Practice Address - Country:US
Practice Address - Phone:954-701-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA 000989224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant