Basic Information
| Provider Information | |||||||||
| NPI: | 1538538889 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TRIFONE | ||||||||
| FirstName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 CABOT ST | ||||||||
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| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021864218 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 233 MIDDLE ST | ||||||||
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| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021844840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818431860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2015 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 11678 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.