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NPI Code Detail

MEDICARE: NICOLE CARDILLO OTRL

MEDICARE:   NICOLE  CARDILLO  OTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist020104NY

General Provider Information

NPI Number : 1316390529
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE CARDILLO OTRL
Provider Business Mailing Address
First Line : 2250 BERGEN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-6611
Country : US
Telephone Number : 917-355-5495
Fax Number :
Provider Business Practice Location Address
First Line : 2250 BERGEN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-6611
Country : US
Telephone Number : 917-355-5495
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2016
Last Update Date : 07/22/2016

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Directions to “ NICOLE CARDILLO OTRL” Practice Location

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