Provider Demographics
NPI:1386464857
Name:NICOLETTE KOMIE & ASSOCIATES LLC
Entity type:Organization
Organization Name:NICOLETTE KOMIE & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMIE
Authorized Official - Suffix:
Authorized Official - Credentials:DT
Authorized Official - Phone:847-275-4115
Mailing Address - Street 1:1871 BUTTERNUT LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6017
Mailing Address - Country:US
Mailing Address - Phone:847-275-4115
Mailing Address - Fax:847-868-9222
Practice Address - Street 1:1871 BUTTERNUT LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6017
Practice Address - Country:US
Practice Address - Phone:847-275-4115
Practice Address - Fax:847-868-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty