=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801100565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE D. PILEGGI OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2010
-----------------------------------------------------
Last Update Date | 02/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 WORLDS FAIR DR SUITE M
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-1364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-356-5363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 488 AUTEN RD UNIT 1D
-----------------------------------------------------
City | HILLSBOROUGH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08844-5053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-589-0839
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT - 007413
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 46TR00553200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------