Active NPI
Nicole Wilson
- Occupational Therapist
- Davie, FL
National Provider Identifier
1003147489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT13641
- Practice address
- 3301 College Ave
Davie, FL 33314-7721 - Phone
- (954) 262-7124
- NPI assigned
- Jan 25, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT13641 | FL | Primary |
Addresses
Primary practice location
3301 College Ave
Davie, FL 33314-7721
Mailing address
1734 E Harmony Lake Cir
Davie, FL 33324-7123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT13641 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290038400000",
"number": "1003147489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1734 E HARMONY LAKE CIR",
"city": "DAVIE",
"state": "FL",
"postal_code": "333247123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 COLLEGE AVE",
"city": "DAVIE",
"state": "FL",
"postal_code": "333147721",
"telephone_number": "954-262-7124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-25",
"last_updated": "2010-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT13641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.