Provider Demographics
NPI:1447773858
Name:CORREIA, NIKITA ANN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:NIKITA
Middle Name:ANN
Last Name:CORREIA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:ANN
Other - Last Name:DUPRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:172 MCGOWAN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-2928
Mailing Address - Country:US
Mailing Address - Phone:774-644-7696
Mailing Address - Fax:
Practice Address - Street 1:233 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4840
Practice Address - Country:US
Practice Address - Phone:781-843-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4193224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant