Provider Demographics
NPI:1508546268
Name:NOVAKOSKI, NANCY (OTR)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NOVAKOSKI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16800 ERINS WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-9767
Mailing Address - Country:US
Mailing Address - Phone:517-230-4698
Mailing Address - Fax:
Practice Address - Street 1:16800 ERINS WAY
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-9767
Practice Address - Country:US
Practice Address - Phone:517-230-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT24490225X00000X
MI5201002809225X00000X
AL6163225X00000X
IN31007922A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist