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NPI Code Detail

MEDICARE: NICOLE DEWITT OTRL

MEDICARE: NICOLE DEWITT OTRL
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
1174400000XSpecialistOT-006791OH

General Provider Information

NPI Number : 1891840419
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE DEWITT OTRL
Provider Business Mailing Address
First Line : 240 MARKET ST
Second Line : 330
City : WESTLAKE
State : OH
Zip : 44145-8110
Country : US
Telephone Number : 440-309-7867
Fax Number :
Provider Business Practice Location Address
First Line : 10011 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-4701
Country : US
Telephone Number : 216-791-8363
Fax Number : 216-791-2539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 02/27/2008

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Directions to “ NICOLE DEWITT OTRL” Practice Location

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