Nicole Petrillo, MS, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OC012620 Issued in PA

Practice address

4065 1St Ave
Lafayette Hill, PA 19444-1417

Phone

(610) 306-4688

NPI assigned

Sep 3, 2024

Last updated

Sep 8, 2024By the provider in NPPES

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

Other names 1

• Nicole Bishara Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725753600000",
    "number": "1255166922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4065 1ST AVE",
            "city": "LAFAYETTE HILL",
            "state": "PA",
            "postal_code": "194441417",
            "telephone_number": "610-306-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4065 1ST AVE",
            "city": "LAFAYETTE HILL",
            "state": "PA",
            "postal_code": "194441417",
            "telephone_number": "610-306-4688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLO",
        "first_name": "NICOLE",
        "credential": "MS, OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-09-08",
        "certification_date": "2024-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC012620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BISHARA",
            "credential": "MS, OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in Lafayette Hill, PA
• Providers in Lafayette Hill, PA by specialty
• Occupational Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2024; 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.