Provider Demographics
NPI:1306354535
Name:PREDVIL, NITCHELLE (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:NITCHELLE
Middle Name:
Last Name:PREDVIL
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-2551
Mailing Address - Country:US
Mailing Address - Phone:908-267-8565
Mailing Address - Fax:
Practice Address - Street 1:303 ROCK AVE
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2616
Practice Address - Country:US
Practice Address - Phone:732-968-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009124225X00000X
NJ46T00819600225X00000X
NY022023-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist