MEDICARE: MRS. NICHOLE K RODE

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	225XP0200X	Pediatric Occupational Therapist	OT7979	OH

General Provider Information

NPI Number	:	1316782576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICHOLE K RODE

Provider Business Mailing Address
First Line	:	6011 BUETTNER RD
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9025
Country	:	US
Telephone Number	:	419-234-0988
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 ELIDA AVE
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-1785
Country	:	US
Telephone Number	:	419-234-0988
Fax Number	:

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

Provider Enumeration Date	:	06/28/2024
Last Update Date	:	06/28/2024

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Directions to “ MRS. NICHOLE K RODE ” Practice Location

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