Individual
NICOLE BLOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
1422 W WILLOW ST, CHICAGO, IL 60642-8978
(773) 630-4400
Mailing address
1940 N LINCOLN AVE APT 203, CHICAGO, IL 60614-5428
(310) 408-1235
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056014589
IL
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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