Provider Demographics
NPI:1497243729
Name:NASH, NICOLE (LOTR)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 E HONORS POINT CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5781
Mailing Address - Country:US
Mailing Address - Phone:504-481-3142
Mailing Address - Fax:
Practice Address - Street 1:330 FALCONER DR STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8211
Practice Address - Country:US
Practice Address - Phone:985-900-2305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist