Provider Demographics
NPI:1811302383
Name:HANEY, NICOLE M (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:HANEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:OROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:109 WIND HAVEN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8010
Mailing Address - Country:US
Mailing Address - Phone:859-224-2273
Mailing Address - Fax:859-224-4675
Practice Address - Street 1:109 WIND HAVEN DR STE 100
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-224-2273
Practice Address - Fax:859-224-4675
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5802225XP0200X
KY135802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000880081OtherANTHEM
KYK145090Medicare PIN