Provider Demographics
NPI:1215254313
Name:SMITH, NICOLE HINSON (COTA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:HINSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SOUTHWIND TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-6102
Mailing Address - Country:US
Mailing Address - Phone:704-575-0930
Mailing Address - Fax:
Practice Address - Street 1:1005 SOUTHWIND TRAIL DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-6102
Practice Address - Country:US
Practice Address - Phone:704-575-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5346251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health