Provider Demographics
NPI:1386615524
Name:MEYERS, NICOLE R (OT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:MEYERS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:MAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-2611
Mailing Address - Country:US
Mailing Address - Phone:507-526-5611
Mailing Address - Fax:
Practice Address - Street 1:717 S STATE ST
Practice Address - Street 2:SUITE 900
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:507-238-4949
Practice Address - Fax:507-238-3377
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102391225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN30D04MEOtherBXBS