Provider Demographics
NPI:1184294282
Name:ABBOTT, NIKKI MARIE (CTRS)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:MARIE
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 KITTERY ST NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9305
Mailing Address - Country:US
Mailing Address - Phone:616-334-0984
Mailing Address - Fax:
Practice Address - Street 1:4837 KITTERY ST NW
Practice Address - Street 2:
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-9305
Practice Address - Country:US
Practice Address - Phone:616-334-0984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI82808225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist