Provider Demographics
NPI:1982870226
Name:WARD, NICOLE MAC DONALD (OT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MAC DONALD
Last Name:WARD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAMMETT AVE
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3706
Mailing Address - Country:US
Mailing Address - Phone:540-731-0384
Mailing Address - Fax:
Practice Address - Street 1:110 HAMMETT AVE
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-3706
Practice Address - Country:US
Practice Address - Phone:540-731-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001294225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist