Provider Demographics
NPI:1891718730
Name:NANNA, NICHOLAS P (OTR L)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:P
Last Name:NANNA
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 EAST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2192
Mailing Address - Country:US
Mailing Address - Phone:585-263-2850
Mailing Address - Fax:585-263-2885
Practice Address - Street 1:720 EAST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2192
Practice Address - Country:US
Practice Address - Phone:585-263-2850
Practice Address - Fax:585-263-2885
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007199-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist