| NPI | 1487137220 |
|---|---|
| Former Name | NICOLE RAE LAVIGNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: WI 5534-27) |
| Additional Taxonomies | 226000000X Recreational Therapist Assistant (Licence: WI 5534-27) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2018-09-07 |