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Individual

MS. NICOLE THAWLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS OTR/L

Contact information

Practice address
450 SAINT PAULS PL, BRONX, NY 10456-1938
(973) 769-9316
Mailing address
1011 GRACE TER, TEANECK, NJ 07666-2622
(973) 769-9316

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
46TR00488800
NJ
225X00000X
Occupational Therapist
63 015616
NY
225XP0200X
Pediatric Occupational Therapist
46TR00488800
NJ
225XP0200X
Pediatric Occupational Therapist
Primary
63 015616
NY

Other

Enumeration date
04/27/2012
Last updated
04/27/2012
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