Healthcare Provider Details

I. General information

NPI: 1790689958
Provider Name (Legal Business Name): CAITLYN NICHOLSON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL STE 306A
LINCOLN RI
02865-1112
US

IV. Provider business mailing address

28 COOKE DR
NORTH SCITUATE RI
02857-1608
US

V. Phone/Fax

Practice location:
  • Phone: 401-443-5252
  • Fax:
Mailing address:
  • Phone: 401-580-4096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT02485
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: