MEDICARE: MS. NICOLE M LOFFREDO 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	225X00000X	Occupational Therapist	026944	NY

General Provider Information

NPI Number	:	1780305722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE M LOFFREDO OTR/L

Provider Business Mailing Address
First Line	:	15 DENTON PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1807
Country	:	US
Telephone Number	:	347-885-5564
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3920
Country	:	US
Telephone Number	:	718-475-5100
Fax Number	:

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

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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