Provider Demographics
NPI:1396033759
Name:STRAW, NICOLE RAE (MA OTR,L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:STRAW
Suffix:
Gender:F
Credentials:MA OTR,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-8964
Mailing Address - Country:US
Mailing Address - Phone:763-234-9250
Mailing Address - Fax:
Practice Address - Street 1:141 OAK AVE
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-8964
Practice Address - Country:US
Practice Address - Phone:763-234-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist