Provider Demographics
NPI:1902397888
Name:LIGHTCAP, NICHOLE VALERIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:VALERIE
Last Name:LIGHTCAP
Suffix:
Gender:F
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 1:12 RHODODENDRON ST
Mailing Address - Street 2:
Mailing Address - City:STARFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15777-9610
Mailing Address - Country:US
Mailing Address - Phone:724-422-1865
Mailing Address - Fax:
Practice Address - Street 1:1464 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2609
Practice Address - Country:US
Practice Address - Phone:814-249-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013435225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics