Healthcare Provider Details

I. General information

NPI: 1851301212
Provider Name (Legal Business Name): NICOLE LEIGH O'MALLEY MA MT-BC NMT/F LPMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W INDEPENDENCE WAY STE B
KINGSTON RI
02881
US

IV. Provider business mailing address

PO BOX 5333
WAKEFIELD RI
02880-5333
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-4810
  • Fax:
Mailing address:
  • Phone: 401-783-4810
  • Fax: 401-783-4810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberMUS00001
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: