Individual
NICOLE BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
815 WENTWORTH DR NE, CONCORD, NC 28025-7812
(704) 796-2850
Mailing address
815 WENTWORTH DR NE, CONCORD, NC 28025-7812
(704) 796-2850
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
9777
NC
Other
Enumeration date
02/27/2016
Last updated
02/27/2016
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