Healthcare Provider Details

I. General information

NPI: 1740184555
Provider Name (Legal Business Name): NICOLE POLLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIN ST STE 108A
CENTERBROOK CT
06409-1057
US

IV. Provider business mailing address

3 RAILROAD AVE
CHESTER CT
06412-1216
US

V. Phone/Fax

Practice location:
  • Phone: 860-227-5051
  • Fax:
Mailing address:
  • Phone: 860-227-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number48.003838
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: