MEDICARE: JULIE NICHOLSON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	46TR00885100	NJ

General Provider Information

NPI Number	:	1003580317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE NICHOLSON OTR/L

Provider Business Mailing Address
First Line	:	408 POMPTON AVE
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1813
Country	:	US
Telephone Number	:	973-433-0732
Fax Number	:	973-433-0733

Provider Business Practice Location Address
First Line	:	361 MONTGOMERY ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3345
Country	:	US
Telephone Number	:	201-932-2656
Fax Number	:	201-932-2656

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	10/18/2022

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