MEDICARE: NICOLE EILEEN TABABA OTD, 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

General Provider Information

NPI Number	:	1447004585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE EILEEN TABABA OTD, OTR/L

Provider Business Mailing Address
First Line	:	1025 HARDING AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-6116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 SOUTHERN BLVD
Second Line	:
City	:	CHATHAM
State	:	NJ
Zip	:	07928-1488
Country	:	US
Telephone Number	:	973-822-1500
Fax Number	:

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

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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