Provider Demographics
NPI:1801253596
Name:TROYAN, NICOLE (OTA/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:TROYAN
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:RIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA/L
Mailing Address - Street 1:310 CEDAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-9463
Mailing Address - Country:US
Mailing Address - Phone:561-756-7983
Mailing Address - Fax:
Practice Address - Street 1:6100 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4160
Practice Address - Country:US
Practice Address - Phone:336-292-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9552224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9552OtherOTA LICENSE