Nicole Lauren Trumbo, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

3511 Issued in NM

Practice address

619 S Knik Goose Bay Rd
Wasilla, AK 99654-8075

Phone

(907) 982-3897

NPI assigned

Apr 22, 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

Other names 1

• Nicole Lauren Hager Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Backcountry Therapeutics LLC

  • Occupational Therapist
  • Wasilla, AK
  • NPI 1184022550
  NPD (past)

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

{
    "created_epoch": "1461283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461283200000",
    "number": "1922452259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 876104",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996876104",
            "telephone_number": "907-982-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 S KNIK GOOSE BAY RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996548075",
            "telephone_number": "907-982-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRUMBO",
        "first_name": "NICOLE",
        "middle_name": "LAUREN",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-22",
        "last_updated": "2016-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NM",
            "license": "3511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "HAGER",
            "middle_name": "LAUREN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• True North Recovery Inc
• True North Recovery Inc
• True North Recovery Inc
• Tammy M Trulove
• Dillon Trumbo, COTA
• Trust the Journey, LLC
• Sasha Ann Tsurnos, LMSW, PSPIII, CDCS
• Sheena M Tuck
• Adam Tudor, D.C.
• Elizabeth Tunnell

• Occupational Therapy Assistant in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Occupational Therapy Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.