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General NPI Number Information
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NPI Number | 1215801097
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Entity Type | Individual
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Provider Name | NICOLE SHEA
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Gender |
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 1050 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2509
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Country | US
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Telephone | 732-475-4959
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Fax | 732-780-7139
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Provider Business Mailing Address
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Address Line | 1050 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2509
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Country | US
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Telephone | 732-475-4959
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Fax | 732-780-7139
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 46TR01262200
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License Number State | NJ
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