Provider Demographics
NPI:1902398399
Name:ABBOTT, NICOLE MARIE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:ABBOTT
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:GOETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2660 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2442
Mailing Address - Country:US
Mailing Address - Phone:785-354-6116
Mailing Address - Fax:
Practice Address - Street 1:2660 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2442
Practice Address - Country:US
Practice Address - Phone:785-354-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty