Healthcare Provider Details

I. General information

NPI: 1306365739
Provider Name (Legal Business Name): NICHOLE MARIE BELL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 HOSPITAL DRIVE
ST JOHNSBURY VT
05819
US

IV. Provider business mailing address

32 MILLBROOK RD
WAYLAND MA
01778
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-8757
  • Fax:
Mailing address:
  • Phone: 508-494-5984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: