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General NPI Number Information
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NPI Number | 1831978030
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Entity Type | Individual
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Provider Name | NICOLE PATRICE VINE-BRAUN
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Gender | Female
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 31869 CHICAGO TRL
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City | NEW CARLISLE
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State | IN
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Zip | 46552-9639
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Country | US
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Telephone | 574-654-2266
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Fax |
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Provider Business Mailing Address
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Address Line | 33927 PRAIRIE EDGE DR
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City | NEW CARLISLE
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State | IN
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Zip | 46552-8253
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Country | US
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Telephone | 317-408-2020
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 31003762A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225XE0001X
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Taxonomy Name | Environmental Modification Occupational Therapist
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License Number | 31003762A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 31003762A
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License Number State | IN
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