Provider Demographics
NPI:1316169188
Name:FILICE, NICOLE ANN (OTRL)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANN
Last Name:FILICE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 LUPINE CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7405
Mailing Address - Country:US
Mailing Address - Phone:408-847-3774
Mailing Address - Fax:
Practice Address - Street 1:1483 LUPINE CT
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7405
Practice Address - Country:US
Practice Address - Phone:408-847-3774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 768225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist