MEDICARE: NICOLE SKIDMORE 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	OT011631	OH

General Provider Information

NPI Number	:	1629534490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SKIDMORE OTR/L

Provider Business Mailing Address
First Line	:	228 PARKVIEW DR
Second Line	:
City	:	AURORA
State	:	OH
Zip	:	44202-8057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12801 BANGOR AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3660
Country	:	US
Telephone Number	:	216-475-8123
Fax Number	:

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

Provider Enumeration Date	:	02/15/2019
Last Update Date	:	12/19/2025

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Directions to “ NICOLE SKIDMORE OTR/L” Practice Location

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