Provider Demographics
NPI:1992185722
Name:VICINO, NICOLE MARIE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:MARIE
Last Name:VICINO
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 1:9225 CARLTON HILLS BLVD
Mailing Address - Street 2:23
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2980
Mailing Address - Country:US
Mailing Address - Phone:619-692-0622
Mailing Address - Fax:
Practice Address - Street 1:9225 CARLTON HILLS BLVD
Practice Address - Street 2:23
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2980
Practice Address - Country:US
Practice Address - Phone:619-692-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-06
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT14410225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics