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NPI Code Detail

MEDICARE: NICOLE LEWIS MS, OTR/L

MEDICARE: NICOLE LEWIS MS, 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
1225X00000XOccupational Therapist013004-1NY

General Provider Information

NPI Number : 1104243625
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LEWIS MS, OTR/L
Provider Business Mailing Address
First Line : 7323 210TH ST
Second Line : APT 6G
City : BAYSIDE
State : NY
Zip : 11364-2852
Country : US
Telephone Number : 516-424-4384
Fax Number :
Provider Business Practice Location Address
First Line : 805 KENT AVE
Second Line : SUITE 101
City : BROOKLYN
State : NY
Zip : 11205-1581
Country : US
Telephone Number : 516-424-4384
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2014
Last Update Date : 03/21/2014

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