Nicole R Skodack, CTRS

Primary specialty

Recreation TherapistTaxonomy code 225800000X

Practice address

1719 Wisconsin Ave
Grand Haven, MI 49417-2576

Phone

(616) 540-4911

NPI assigned

Aug 23, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471910400000",
    "number": "1235684986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 WISCONSIN AVE",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172576",
            "telephone_number": "616-540-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 WISCONSIN AVE",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172576",
            "telephone_number": "616-540-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKODACK",
        "first_name": "NICOLE",
        "middle_name": "R",
        "credential": "CTRS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-23",
        "last_updated": "2016-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Recreation Therapist in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Recreation Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.