Provider Demographics
NPI:1194052399
Name:DELIA, NICOLE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:DELIA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GREEN HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5304
Mailing Address - Country:US
Mailing Address - Phone:845-206-6728
Mailing Address - Fax:
Practice Address - Street 1:40 JON BARRETT RD
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2164
Practice Address - Country:US
Practice Address - Phone:845-878-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015899-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist