Provider Demographics
NPI:1093831331
Name:MAHER, NICOLE LYNN (MS, OTRL, CHT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:MAHER
Suffix:
Gender:F
Credentials:MS, OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14136
Mailing Address - Country:US
Mailing Address - Phone:716-913-5211
Mailing Address - Fax:
Practice Address - Street 1:7755 ROUTE 83
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTON
Practice Address - State:NY
Practice Address - Zip Code:14138-9633
Practice Address - Country:US
Practice Address - Phone:716-913-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0126991225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0766Medicare PIN