Active NPI
Laura Lee Nicholson, OTR L
- Occupational Therapist
- Raleigh, NC
National Provider Identifier
1023212057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4550
- Practice address
- 3001 Spring Forest Rd
Raleigh, NC 27616-2815 - Phone
- (910) 724-7770
- NPI assigned
- Jun 13, 2007
- Last updated
- Jul 23, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 4550 | NC | Primary |
Addresses
Primary practice location
3001 Spring Forest Rd
Raleigh, NC 27616-2815
Mailing address
5513 Monarch Birch Dr
Apex, NC 27539-5747
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 |
|---|---|---|---|
| 4550 | NC | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Healthcare Services Massachusetts LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Westborough, MA
- NPI 1962108761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595462400000",
"number": "1023212057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5513 MONARCH BIRCH DR",
"city": "APEX",
"state": "NC",
"postal_code": "275395747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 SPRING FOREST RD",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276162815",
"telephone_number": "910-724-7770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "LAURA",
"middle_name": "LEE",
"name_prefix": "Miss",
"credential": "OTR L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-13",
"last_updated": "2020-07-23",
"certification_date": "2020-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "4550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.