Provider Demographics
NPI:1902292626
Name:HADLEY, NICOLE L (COTA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:HADLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:4758 E HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-6616
Mailing Address - Country:US
Mailing Address - Phone:317-797-4056
Mailing Address - Fax:
Practice Address - Street 1:4758 E HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-6616
Practice Address - Country:US
Practice Address - Phone:317-797-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002113A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility