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General NPI Number Information
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NPI Number | 1659103232
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Entity Type | Individual
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Provider Name | NICOLE MARIE WHITTAKER
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Gender | Female
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | AREA 27, BUILDING H200T
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City | OCEANSIDE
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State | CA
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Zip | 92055
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Country | US
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Telephone | 760-725-0063
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 LUKUP LN APT 101
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City | COSTA MESA
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State | CA
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Zip | 92626-6709
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Country | US
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Telephone | 714-483-5338
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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 | 6727
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number | 30957
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License Number State | CA
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