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Individual
NICOLE MARIE SLACK
Active
Individual
NICOLE MARIE SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0119004412
VA
225X00000X
Occupational Therapist
056007779
IL
225X00000X
Occupational Therapist
112483
TX
225X00000X
Occupational Therapist
3382
SC
225X00000X
Occupational Therapist
3934
AZ
225X00000X
Occupational Therapist
5201006711
MI
225X00000X
Occupational Therapist
Primary
OT004788
GA
Other
Enumeration date
09/15/2008
Last updated
09/15/2008
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