| NPI | 1629438353 |
|---|---|
| Former Name | NICOLE MAXWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.022119) |
| 225X00000X Occupational Therapist | |
| 225X00000X Occupational Therapist (Licence: IL 056.011384) | |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2023-03-20 |