Provider Demographics
NPI:1699114306
Name:MCALISTER, NICOLE M (OTR/L)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:MCALISTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6130
Mailing Address - Country:US
Mailing Address - Phone:708-698-5259
Mailing Address - Fax:
Practice Address - Street 1:3039 REDSKIN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-9252
Practice Address - Country:US
Practice Address - Phone:773-454-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009991225X00000X
IN31007022A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist