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NPI Code Detail

MEDICARE: MRS. NICOLE MARIE MITCHELL OTR/L

MEDICARE: MRS. NICOLE MARIE MITCHELL 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
1225XP0200XPediatric Occupational Therapist5161NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1136YGOTHERNCBLUE CROSS/BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780606079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE MARIE MITCHELL OTR/L
Provider Business Mailing Address
First Line : 577 PIMLICO CIR
Second Line :
City : WHITSETT
State : NC
Zip : 27377-8713
Country : US
Telephone Number : 336-603-4052
Fax Number :
Provider Business Practice Location Address
First Line : 714 GREEN VALLEY RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27408-7018
Country : US
Telephone Number : 336-370-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 04/17/2026

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