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General NPI Number Information
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NPI Number | 1790266856
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Entity Type | Individual
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Provider Name | NIKOLE S BRIM AAS,COTA
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 320 W BELT LINE RD STE 4032ND
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City | CEDAR HILL
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State | TX
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Zip | 75104-2096
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Country | US
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Telephone | 214-470-0035
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Fax | 888-371-6987
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Provider Business Mailing Address
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Address Line | 2845 LIVERPOOL LN
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-8383
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Country | US
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Telephone | 214-470-0035
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Fax | 888-371-6987
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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 | 215377
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License Number State | TX
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