Provider Demographics
NPI:1295705499
Name:LOSTY, NIKKI L (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NIKKI
Middle Name:L
Last Name:LOSTY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:NIKKI
Other - Middle Name:L
Other - Last Name:ROTHFUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:24 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-499-4991
Mailing Address - Fax:413-499-4922
Practice Address - Street 1:24 PARK STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-4991
Practice Address - Fax:413-499-4922
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7932225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT0275Medicaid
MA36479OtherHEALTH NEW ENGLAND
MAOT0010OtherBCBSMA
MAAA33949OtherHARVARD PILGRIM HEALTHCAR
MA36479OtherHEALTH NEW ENGLAND