Provider Demographics
NPI:1023529179
Name:ALLEN, NICOLE LOUISE (MS OTR/L)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 NATANIS RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-6334
Mailing Address - Country:US
Mailing Address - Phone:302-531-7925
Mailing Address - Fax:
Practice Address - Street 1:5 NURSING HOME DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-7344
Practice Address - Country:US
Practice Address - Phone:603-542-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist