Active NPI
Nicole Fay Wall, B.S.
- Occupational Therapist
- Hernando, FL
National Provider Identifier
1306020599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT11286
- Practice address
- 778 West Cockatiel Loop
Hernando, FL 34442 - Phone
- (305) 308-5816
- Fax
- (305) 243-3155
- NPI assigned
- Dec 24, 2007
- 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 | OT11286 | FL | Primary |
Addresses
Primary practice location
778 West Cockatiel Loop
Hernando, FL 34442
Mailing address
778 West Cockatiel Loop
Hernando, FL 34442
Phone (305) 308-5816
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 889443400 | Medicaid | FL |
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT11286 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198454400000",
"number": "1306020599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "778 WEST COCKATIEL LOOP",
"city": "HERNANDO",
"state": "FL",
"postal_code": "34442",
"telephone_number": "305-308-5816",
"fax_number": "305-243-3155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "778 WEST COCKATIEL LOOP",
"city": "HERNANDO",
"state": "FL",
"postal_code": "34442",
"telephone_number": "305-308-5816",
"fax_number": "305-243-3155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "NICOLE",
"middle_name": "FAY",
"name_prefix": "Ms.",
"credential": "B.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-24",
"last_updated": "2007-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT11286",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "889443400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hernando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.