Provider Demographics
NPI:1922656206
Name:ORTEGA, NICOLE MARIE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W BURTON PL APT 1108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1466
Mailing Address - Country:US
Mailing Address - Phone:417-429-5490
Mailing Address - Fax:
Practice Address - Street 1:8707 SKOKIE BLVD STE 402
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2269
Practice Address - Country:US
Practice Address - Phone:847-877-5210
Practice Address - Fax:847-510-0430
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2023-11-27
Deactivation Date:2019-09-04
Deactivation Code:
Reactivation Date:2019-10-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist