Nichole Lavalley

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

ALLS 2297 Issued in ME

Practice address

1461 Moosehead TRL
Jackson, ME 04921

Phone

(207) 907-2631

NPI assigned

Feb 7, 2007

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572393600000",
    "number": "1821138017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 LOWER DETROIT RD",
            "city": "PLYMOUTH",
            "state": "ME",
            "postal_code": "049693213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 MOOSEHEAD TRL",
            "city": "JACKSON",
            "state": "ME",
            "postal_code": "04921",
            "telephone_number": "207-907-2631"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "119 Lower Detroit Rd",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "ME",
            "postal_code": "049693213",
            "country_code": "US",
            "telephone_number": "207-257-2131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAVALLEY",
        "first_name": "NICHOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2019-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "ME",
            "license": "ALLS 2297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodi Dodge, RN
• Meghan Hinton Easley, OT
• Allyn Eldridge, COTA/L
• Shannon L Klein
• John C. Kraft, ACSW
• Vicki Laverne Merritt, CCC-SLP
• Omni Integrative Wellness Inc.

• All providers in Jackson, ME
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; 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.