MEDICARE: NICOLE FONTAINE

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	13-0333	NV

General Provider Information

NPI Number	:	1619834942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE FONTAINE

Provider Business Mailing Address
First Line	:	3324 INDIAN SHADOW ST UNIT 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3324 INDIAN SHADOW ST UNIT 204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8628
Country	:	US
Telephone Number	:	413-262-8433
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ NICOLE FONTAINE ” Practice Location

Language	Start Address	Practice Location

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