Healthcare Provider Details

I. General information

NPI: 1740308824
Provider Name (Legal Business Name): DANIELLE NICOLETTI OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 LIMERICK RD
ARUNDEL ME
04046-8158
US

IV. Provider business mailing address

74 DAYTON LN
DAYTON ME
04005-7032
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-7861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT2037
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: