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General NPI Number Information
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NPI Number | 1275962532
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Entity Type | Individual
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Provider Name | NICOLE COVELY
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 500 W LAUREL ST
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City | FRACKVILLE
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State | PA
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Zip | 17931-2018
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Country | US
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Telephone | 570-874-0696
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Fax |
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Provider Business Mailing Address
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Address Line | 313 E PATTERSON ST
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City | SAINT CLAIR
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State | PA
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Zip | 17970-1354
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OP007360
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License Number State | PA
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