Provider Demographics
NPI:1942955588
Name:WOLFE, NICOLE ASHLEY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ASHLEY
Last Name:WOLFE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ASHLEY
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:12400 S HIWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-7681
Mailing Address - Country:US
Mailing Address - Phone:405-833-1013
Mailing Address - Fax:
Practice Address - Street 1:12400 S HIWASSEE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-7681
Practice Address - Country:US
Practice Address - Phone:405-833-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1145224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1145Medicaid