Provider Demographics
NPI:1548074248
Name:DIGOUT, NICOLE (OT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DIGOUT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 2ND PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3402
Mailing Address - Country:US
Mailing Address - Phone:647-919-2298
Mailing Address - Fax:
Practice Address - Street 1:51 SAINT EDWARDS ST STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3184
Practice Address - Country:US
Practice Address - Phone:718-858-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029836225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist