Provider Demographics
NPI:1548597768
Name:DEVONA, NICOLE (COTA/L)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:DEVONA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 ERIN DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1755
Mailing Address - Country:US
Mailing Address - Phone:860-382-3616
Mailing Address - Fax:
Practice Address - Street 1:20 BABCOCK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1226
Practice Address - Country:US
Practice Address - Phone:860-230-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1154224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant