MEDICARE: NICOLE MARIE CONNORS OTR/L, DROT

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	OC016475	PA

General Provider Information

NPI Number	:	1023974094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE CONNORS OTR/L, DROT

Provider Business Mailing Address
First Line	:	2100 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2633
Country	:	US
Telephone Number	:	862-202-3714
Fax Number	:

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

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/12/2026

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