Basic Information
Provider Information
NPI: 1003000647
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEPORE
FirstName: NICOLE
MiddleName: MARIE
NamePrefix: MS.
NameSuffix:  
Credential: MS, OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20 FEN CT
Address2:  
City: MADISON
State: NJ
PostalCode: 079402317
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 20 FEN CT
Address2:  
City: MADISON
State: NJ
PostalCode: 079402317
CountryCode: US
TelephoneNumber: 2016027406
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/28/2007
LastUpdateDate: 03/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XP0200X46TR00426800NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics

No ID Information.


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