Provider Demographics
NPI:1891399770
Name:NAVE, NICOLE EMILY
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:EMILY
Last Name:NAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 STRAITS TPKE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1836
Mailing Address - Country:US
Mailing Address - Phone:203-598-0600
Mailing Address - Fax:203-598-3300
Practice Address - Street 1:84 OXFORD RD
Practice Address - Street 2:RT 67
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-1971
Practice Address - Country:US
Practice Address - Phone:203-881-0830
Practice Address - Fax:203-881-0894
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2125225200000X
CT2125225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant