Provider Demographics
NPI:1205467701
Name:SIMINSKI, NICOLE DANIELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE
Last Name:SIMINSKI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DANIELLE
Other - Last Name:SION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:9992 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST CONCORD
Mailing Address - State:NY
Mailing Address - Zip Code:14055-9745
Mailing Address - Country:US
Mailing Address - Phone:716-574-7000
Mailing Address - Fax:
Practice Address - Street 1:393 NORTH ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-9652
Practice Address - Country:US
Practice Address - Phone:716-592-9331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010246224Z00000X
NY010246-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant