Individual
CORAL NICOLE HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
30 TAVERNIER DR UNIT B30, PONTE VEDRA BEACH, FL 32081-0677
(904) 404-2345
(904) 789-6295
Mailing address
30 TAVERNIER DR UNIT B, PONTE VEDRA BEACH, FL 32081-0677
(904) 404-2345
(904) 789-6295
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
21961
FL
Other
Enumeration date
08/06/2021
Last updated
07/22/2024
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