Provider Demographics
NPI:1588078935
Name:ANDREESEN, NICOLE L (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:ANDREESEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:ERIKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2305 SOUTH TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108
Mailing Address - Country:US
Mailing Address - Phone:402-880-0254
Mailing Address - Fax:
Practice Address - Street 1:2305 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1108
Practice Address - Country:US
Practice Address - Phone:402-345-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist