Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 05555 | MD |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 9820 | CA |
NPI | 1194953430 |
---|---|
Provider Name | Michelle Kaye F Nicolas |
First Address | Pacifica, CA 94044-3449 |
Second Address | San Francisco, CA 94114-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 11/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9820 | OTR/L (01) | CA |