Provider Demographics
NPI:1801356241
Name:OGLETREE, NICOLE TERESA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TERESA
Last Name:OGLETREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:TERESA
Other - Last Name:FOSCHINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 OLD BLACK HORSE PIKE APT F9
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-4927
Mailing Address - Country:US
Mailing Address - Phone:856-404-0904
Mailing Address - Fax:856-373-5040
Practice Address - Street 1:1501 OLD BLACK HORSE PIKE APT F9
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-4927
Practice Address - Country:US
Practice Address - Phone:856-404-0904
Practice Address - Fax:856-373-5040
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18545225100000X
NJ40QA01967200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist