Provider Demographics
NPI:1811510274
Name:STONE, NICHOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:STONE
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 1:19349 COUNTY ROAD 25 LOT 12
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-9722
Mailing Address - Country:US
Mailing Address - Phone:970-842-4500
Mailing Address - Fax:
Practice Address - Street 1:617 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3426
Practice Address - Country:US
Practice Address - Phone:970-522-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO001803225X00000X
CO0001803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist