Provider Demographics
NPI:1457182271
Name:CRAIGIE, NICOLE NADINE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:NADINE
Last Name:CRAIGIE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 FLORIKAN ST
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-6265
Mailing Address - Country:US
Mailing Address - Phone:818-554-6910
Mailing Address - Fax:
Practice Address - Street 1:13030 BRADLEY AVE
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3831
Practice Address - Country:US
Practice Address - Phone:818-421-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26755225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist