Provider Demographics
NPI:1124668702
Name:HALLIWELL, NICOLE (DSC, OTR/L)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:HALLIWELL
Suffix:
Gender:F
Credentials:DSC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:OLDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08858-0305
Mailing Address - Country:US
Mailing Address - Phone:908-439-9636
Mailing Address - Fax:
Practice Address - Street 1:83 OLD TPKE
Practice Address - Street 2:
Practice Address - City:OLDWICK
Practice Address - State:NJ
Practice Address - Zip Code:08858-7001
Practice Address - Country:US
Practice Address - Phone:908-439-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00594500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist