MEDICARE: MS. NICOLE MAGLARAS M.O.T., 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	11532	CA
2	225X00000X	Occupational Therapist	005705	CT

General Provider Information

NPI Number	:	1245543602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE MAGLARAS M.O.T., OTR/L

Provider Business Mailing Address
First Line	:	51 CLARK HILL RD
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460
Country	:	US
Telephone Number	:	646-529-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 9TH AVE
Second Line	:	UNIT 1
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3244
Country	:	US
Telephone Number	:	619-542-9945
Fax Number	:

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

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	06/26/2023

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