MEDICARE: NICOLE DITCHKUS OTR

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	46TR00695300	NJ

General Provider Information

NPI Number	:	1366331936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DITCHKUS OTR

Provider Business Mailing Address
First Line	:	1221 SLEEPY HOLLOW RD
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 SLEEPY HOLLOW RD
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3524
Country	:	US
Telephone Number	:	908-415-1670
Fax Number	:

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

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	06/30/2025

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