Healthcare Provider Details

I. General information

NPI: 1427397728
Provider Name (Legal Business Name): NICOLE WILSON-RABBANI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 16TH ST NW
WASHINGTON DC
20011-7003
US

IV. Provider business mailing address

1400 IRVING ST NW APT 711
WASHINGTON DC
20010-2850
US

V. Phone/Fax

Practice location:
  • Phone: 707-704-3165
  • Fax:
Mailing address:
  • Phone: 707-704-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010000711
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: