Healthcare Provider Details

I. General information

NPI: 1508299082
Provider Name (Legal Business Name): NICOLE MARIE MAESTRI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4078 ILEX CT
PALM BEACH GARDENS FL
33410-5556
US

IV. Provider business mailing address

4078 ILEX CT
PALM BEACH GARDENS FL
33410-5556
US

V. Phone/Fax

Practice location:
  • Phone: 561-762-9470
  • Fax:
Mailing address:
  • Phone: 561-762-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT15133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: