Individual
NICOLE ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
611 BROADWAY, SUITE 908, NEW YORK, NY 10012-2608
(212) 473-0011
Mailing address
133 MILBURN LN, ROSLYN HEIGHTS, NY 11577-1513
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
021356-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13-3990897
SPOTS
NY
Enumeration date
04/12/2017
Last updated
04/12/2017
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