Individual
NICOLE MARIE TEATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
500 GRAND PLAZA DR, ORANGE CITY, FL 32763-7900
(386) 775-3561
Mailing address
945 GLENWOOD RD, DELAND, FL 32720-2376
(386) 956-3380
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 11355
FL
Other
Enumeration date
01/03/2011
Last updated
01/03/2011
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