Provider Demographics
NPI:1942446216
Name:DEMAINE, NIKKI J (OTR, MBA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:J
Last Name:DEMAINE
Suffix:
Gender:F
Credentials:OTR, MBA
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:29 WHITEOAKS CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5700
Mailing Address - Country:US
Mailing Address - Phone:866-458-1088
Mailing Address - Fax:
Practice Address - Street 1:29 WHITEOAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5700
Practice Address - Country:US
Practice Address - Phone:866-458-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist