MEDICARE: NICOLE TULLY OTR

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	46TR00567000	NJ
2	225X00000X	Occupational Therapist	OC012017	PA

General Provider Information

NPI Number	:	1932481157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE TULLY OTR

Provider Business Mailing Address
First Line	:	63 2ND AVE
Second Line	:
City	:	ROEBLING
State	:	NJ
Zip	:	08554-1001
Country	:	US
Telephone Number	:	609-440-7097
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 JACKSONVILLE RD
Second Line	:
City	:	BURLINGTON TOWNSHIP
State	:	NJ
Zip	:	08016-3814
Country	:	US
Telephone Number	:	609-239-3894
Fax Number	:

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

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	05/18/2015

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