MEDICARE: NICHOLE DECKER

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	224Z00000X	Occupational Therapy Assistant		TX

General Provider Information

NPI Number	:	1184151656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE DECKER

Provider Business Mailing Address
First Line	:	6550 SPRINGFIELD AVE
Second Line	:	STE 101
City	:	LAREDO
State	:	TX
Zip	:	78041-6706
Country	:	US
Telephone Number	:	956-725-4555
Fax Number	:	956-725-3555

Provider Business Practice Location Address
First Line	:	6550 SPRINGFIELD AVE
Second Line	:	STE 101
City	:	LAREDO
State	:	TX
Zip	:	78041-6706
Country	:	US
Telephone Number	:	956-725-4555
Fax Number	:	956-725-3555

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

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	05/16/2017

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Directions to “ NICHOLE DECKER ” Practice Location

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