=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346725538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE PRYOR OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2018
-----------------------------------------------------
Last Update Date | 10/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 FIRST ST NE 9TH FLOOR
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-522-6594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9630 MILESTONE WAY APT 3115
-----------------------------------------------------
City | COLLEGE PARK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20740-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-522-6594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 19170
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT010000351
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------