Provider Demographics
NPI:1023771409
Name:MCNAIR, NICOLE C (COTA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18979 REDLAND RD APT 1204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-3690
Mailing Address - Country:US
Mailing Address - Phone:210-313-3137
Mailing Address - Fax:
Practice Address - Street 1:8645 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1201
Practice Address - Country:US
Practice Address - Phone:210-405-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216278224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant