Individual
MRS. NICOLE IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
103 ROSEHIL RD, SOUTH BOSTON, VA 24592
(434) 517-7527
Mailing address
3071 MULBERRY RD, NATHALIE, VA 24577-3435
(919) 309-5828
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000887
VA
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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