Provider Demographics
NPI:1902488141
Name:PAYNE, NICHOLAS (OT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 ALBERT SABIN WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-2800
Mailing Address - Country:US
Mailing Address - Phone:513-221-0325
Mailing Address - Fax:
Practice Address - Street 1:206 ALBERT SABIN WAY RM 1021
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-9636
Practice Address - Country:US
Practice Address - Phone:513-221-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270122225X00000X
OHOT011984225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist