Active NPI
Jessica Nickolson, OTR
- Occupational Therapist
- Cornelius, NC
National Provider Identifier
1033998372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 16160
- Practice address
- 17315 Shadow Bark Dr
Cornelius, NC 28031-9300 - Phone
- (717) 262-3713
- NPI assigned
- Sep 26, 2023
- 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 | 16160 | NC | Primary |
Addresses
Primary practice location
17315 Shadow Bark Dr
Cornelius, NC 28031-9300
Mailing address
17315 Shadow Bark Dr
Cornelius, NC 28031-9300
Phone (717) 262-3713
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 |
|---|---|---|---|
| 16160 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1033998372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17315 SHADOW BARK DR",
"city": "CORNELIUS",
"state": "NC",
"postal_code": "280319300",
"telephone_number": "717-262-3713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17315 SHADOW BARK DR",
"city": "CORNELIUS",
"state": "NC",
"postal_code": "280319300",
"telephone_number": "717-262-3713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKOLSON",
"first_name": "JESSICA",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-26",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "16160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cornelius, NC
- Neogenix Lake Norman, PC
- Patrice Nerone, LCPC
- Newlife Counseling and Consultation, PLLC
- Lisa Tuyet Nguyen, LCMHC-A
- Emily Carolyn Nichols, FNP-BC
- Meredith Anne Niess, M.D.
- NMG Health Services, LLC (Novant Health Maternal-Fetal Medicine)
- NMMB Enterprise LLC (Rose Pharmacy and Boutique Apothecary)
- Ashley Noone, PA-C
- North Carolina CVS Pharmacy, L.L.C. (CVS Pharmacy #02314)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.