Provider Demographics
NPI:1558825554
Name:CERNY, NICOLE (OTR)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:CERNY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 C ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-4620
Mailing Address - Country:US
Mailing Address - Phone:402-515-8095
Mailing Address - Fax:
Practice Address - Street 1:1611 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2212
Practice Address - Country:US
Practice Address - Phone:760-337-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist