MEDICARE: MRS. NICOLE DEANNE DADDIO OTR/L

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
1	106S00000X	Behavior Technician	RBT-19-78623	CO
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1578801783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE DEANNE DADDIO OTR/L

Provider Business Mailing Address
First Line	:	13780 DEL CORSO WAY APT 1523
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80020-8414
Country	:	US
Telephone Number	:	757-375-0512
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 EUDORA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1248
Country	:	US
Telephone Number	:	757-375-0512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	04/24/2019

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