MEDICARE: NICHOLE MICHELLE FORRER COTA/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	224Z00000X	Occupational Therapy Assistant	OTA007765	OH

General Provider Information

NPI Number	:	1447194733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE MICHELLE FORRER COTA/L

Provider Business Mailing Address
First Line	:	6057 STRIP AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-9207
Country	:	US
Telephone Number	:	330-492-8136
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 GEORGE RED BIRD DR SE
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44646-7104
Country	:	US
Telephone Number	:	330-830-3903
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ NICHOLE MICHELLE FORRER COTA/L” Practice Location

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