Healthcare Provider Details

I. General information

NPI: 1700500360
Provider Name (Legal Business Name): NICOLE DYER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 DILLARD DR
CARY NC
27518-9226
US

IV. Provider business mailing address

1161 LEBANON RD
NORTH BERWICK ME
03906-5512
US

V. Phone/Fax

Practice location:
  • Phone: 919-431-7400
  • Fax:
Mailing address:
  • Phone: 207-459-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17060
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: