Provider Demographics
NPI:1023782026
Name:EPHRAIM, NICOLETTE S (OTD)
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:S
Last Name:EPHRAIM
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 JOHNATHAN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-6015
Mailing Address - Country:US
Mailing Address - Phone:732-546-4083
Mailing Address - Fax:
Practice Address - Street 1:5901 MACARTHUR BLVD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2541
Practice Address - Country:US
Practice Address - Phone:202-349-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09791225X00000X
DCOT010001827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist