Provider Demographics
NPI:1215684287
Name:CASA, NICOLE LOREY (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LOREY
Last Name:CASA
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W WILLIAMS ST UNIT 346
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1998
Mailing Address - Country:US
Mailing Address - Phone:919-448-6018
Mailing Address - Fax:855-254-2501
Practice Address - Street 1:501 W WILLIAMS ST UNIT 346
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1998
Practice Address - Country:US
Practice Address - Phone:919-448-6018
Practice Address - Fax:855-254-2501
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty