Provider Demographics
NPI:1154911683
Name:SCHOTT, NICOLE (MSOT, OTRL)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:SCHOTT
Suffix:
Gender:F
Credentials:MSOT, OTRL
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:MI
Mailing Address - Zip Code:48097-2953
Mailing Address - Country:US
Mailing Address - Phone:810-357-4967
Mailing Address - Fax:
Practice Address - Street 1:2601 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6587
Practice Address - Country:US
Practice Address - Phone:810-216-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist