Provider Demographics
NPI:1699982033
Name:OTOOLE, NICOLE (MS, OTR)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:OTOOLE
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BASNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR
Mailing Address - Street 1:4740 N LAPORTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3801
Mailing Address - Country:US
Mailing Address - Phone:773-426-9270
Mailing Address - Fax:
Practice Address - Street 1:4740 N LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3801
Practice Address - Country:US
Practice Address - Phone:773-426-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-006810225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics