Healthcare Provider Details

I. General information

NPI: 1891399770
Provider Name (Legal Business Name): NICOLE EMILY NAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 OXFORD RD RT 67
OXFORD CT
06478-1971
US

IV. Provider business mailing address

1625 STRAITS TPKE STE 300
MIDDLEBURY CT
06762-1836
US

V. Phone/Fax

Practice location:
  • Phone: 203-881-0830
  • Fax: 203-881-0894
Mailing address:
  • Phone: 203-598-0600
  • Fax: 203-598-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2125
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2125
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: