Provider Demographics
NPI:1780905885
Name:LASWELL, NICOLE ANN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:LASWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-9529
Mailing Address - Country:US
Mailing Address - Phone:215-740-2628
Mailing Address - Fax:
Practice Address - Street 1:111 ELWYN RD # 1
Practice Address - Street 2:
Practice Address - City:ELWYN
Practice Address - State:PA
Practice Address - Zip Code:19063-4622
Practice Address - Country:US
Practice Address - Phone:610-891-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-13
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007119L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist