MEDICARE: LAUREN PAIGE NICOLA OT

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	123174	TX

General Provider Information

NPI Number	:	1801505128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN PAIGE NICOLA OT

Provider Business Mailing Address
First Line	:	PO BOX 852647
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75085-2647
Country	:	US
Telephone Number	:	972-454-9309
Fax Number	:	972-338-9378

Provider Business Practice Location Address
First Line	:	4501 MATLOCK RD STE 401
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-1004
Country	:	US
Telephone Number	:	972-521-6173
Fax Number	:	972-338-9378

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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