Provider Demographics
NPI:1104532639
Name:ECCLES, NICOLE HELEN ELIZABETH (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:HELEN ELIZABETH
Last Name:ECCLES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:21402 CALLE SENDERO
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2157
Mailing Address - Country:US
Mailing Address - Phone:818-489-7238
Mailing Address - Fax:
Practice Address - Street 1:1000 CALLE AMANECER
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6214
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant