Healthcare Provider Details

I. General information

NPI: 1972947422
Provider Name (Legal Business Name): NICOLE MARIE FINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E HURON ST UNIT 1106
CHICAGO IL
60611-2766
US

IV. Provider business mailing address

105 SPECTACLE DR
VALPARAISO IN
46383-1054
US

V. Phone/Fax

Practice location:
  • Phone: 847-997-7157
  • Fax:
Mailing address:
  • Phone: 219-242-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002177A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: