Healthcare Provider Details

I. General information

NPI: 1679904213
Provider Name (Legal Business Name): NICOLE FARRAND OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NORTH ST W
TAWAS CITY MI
48763-9161
US

IV. Provider business mailing address

5679 TOWERLINE RD
HALE MI
48739
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-8647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201008432
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number5201008432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: