Individual
NICOLE LEE GOULDRUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
378 HORSENECK RD, WESTPORT, MA 02790-1337
(508) 493-0188
Mailing address
378 HORSENECK RD, WESTPORT, MA 02790-1337
(508) 493-0188
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA00842
RI
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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