Provider Demographics
NPI:1861522351
Name:CUOMO, NICOLE CHRISTINE (OTR)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:CUOMO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 ROUTE 148
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-2304
Mailing Address - Country:US
Mailing Address - Phone:860-790-0010
Mailing Address - Fax:860-663-3759
Practice Address - Street 1:263 ROUTE 148
Practice Address - Street 2:
Practice Address - City:KILLINGWORTH
Practice Address - State:CT
Practice Address - Zip Code:06419-2304
Practice Address - Country:US
Practice Address - Phone:860-790-0010
Practice Address - Fax:860-663-3759
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist