Active NPI
Nicole Nickell, OT
- Specialist
- Boise, ID
National Provider Identifier
1760788384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OTL-1014
- Practice address
- 6855 W Fairview Ave
Boise, ID 83704-8046 - Phone
- (208) 323-8888
- Fax
- (208) 323-8889
- NPI assigned
- Jan 28, 2011
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | OTL-1014 | ID | Primary |
Addresses
Primary practice location
6855 W Fairview Ave
Boise, ID 83704-8046
Mailing address
6855 W Fairview Ave
Boise, ID 83704-8046
Phone (208) 323-8888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150304002388 | ID | Practitioner - Occupational Therapist in Private Practice | 8426374760 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTL-1014 | ID | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1296172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296172800000",
"number": "1760788384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6855 W FAIRVIEW AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837048046",
"telephone_number": "208-323-8888",
"fax_number": "208-323-8889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6855 W FAIRVIEW AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837048046",
"telephone_number": "208-323-8888",
"fax_number": "208-323-8889"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELL",
"first_name": "NICOLE",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-28",
"last_updated": "2011-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ID",
"license": "OTL-1014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.