Provider Demographics
NPI:1942553136
Name:SYMONS, NICOLE RENEE (COTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:SYMONS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-2020
Mailing Address - Country:US
Mailing Address - Phone:608-732-5125
Mailing Address - Fax:
Practice Address - Street 1:316 SUNSET PL
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456
Practice Address - Country:US
Practice Address - Phone:715-743-5444
Practice Address - Fax:715-743-5448
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI491227224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant