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General NPI Number Information
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NPI Number | 1003148594
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Entity Type | Individual
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Provider Name | KRISTIN NUCKOLS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 110 CANAL ST 3RD FLOOR
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City | LOWELL
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State | MA
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Zip | 01852-4589
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Country | US
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Telephone | 617-671-0789
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Fax | 617-250-8243
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Provider Business Mailing Address
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Address Line | 110 CANAL ST 3RD FLOOR
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City | LOWELL
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State | MA
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Zip | 01852-4589
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Country | US
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Telephone | 617-682-0843
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Fax | 617-250-8243
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 12544
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License Number State | MA
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