Provider Demographics
NPI:1457599219
Name:BAZINET, NICOLE KRISTEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTEN
Last Name:BAZINET
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N PERSON ST APT 206
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1284
Mailing Address - Country:US
Mailing Address - Phone:781-864-3569
Mailing Address - Fax:
Practice Address - Street 1:710 N PERSON ST APT 206
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1284
Practice Address - Country:US
Practice Address - Phone:781-864-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11596225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist