Provider Demographics
NPI:1871158220
Name:BARKER, NICOLE SCHULTZ (OTR//L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SCHULTZ
Last Name:BARKER
Suffix:
Gender:F
Credentials:OTR//L
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:CLARE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:815 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2803
Mailing Address - Country:US
Mailing Address - Phone:847-322-4639
Mailing Address - Fax:
Practice Address - Street 1:760 RED OAK LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3816
Practice Address - Country:US
Practice Address - Phone:847-831-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056012668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist