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General NPI Number Information
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NPI Number | 1245543602
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Entity Type | Individual
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Provider Name | NICOLE MAGLARAS M.O.T., OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 3980 9TH AVE UNIT 1
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City | SAN DIEGO
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State | CA
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Zip | 92103-3244
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Country | US
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Telephone | 619-542-9945
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Fax |
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Provider Business Mailing Address
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Address Line | 51 CLARK HILL RD
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City | MILFORD
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State | CT
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Zip | 06460
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Country | US
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Telephone | 646-529-6070
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Fax |
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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 | 11532
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 005705
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License Number State | CT
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