Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 10635 | NC |
N | 225XE0001X | Environmental Modification | 10635 | NC |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 10635 | NC |
NPI | 1164029690 |
---|---|
Provider Name | Nicole Kathleen Simmler |
First Address | Fayetteville, NC 28314-5272 |
Second Address | Fayetteville, NC 28314-5272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2020 |
Last Update Date | 07/10/2020 |