Individual ProviderNicole WilsonOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address485 Moxie Ln, Delphos, OH 45833-9182(419) 692-3405PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Wilson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1275891434Provider TypeIndividualFull NameWilson, NicoleGenderFemaleSole ProprietorYesEnumeration Date4/25/2012Last Updated4/25/2012Contact InformationPractice LocationPractice Address485 Moxie Ln, Delphos, OH 45833-9182Phone(419) 692-3405Fax(419) 692-3400Mailing LocationMailing Address485 Moxie Ln, Delphos, OH 45833-9182Phone(419) 692-3405Fax(419) 692-3400Provider TaxonomiesCodeDescriptionLicenseCode225X00000XPrimaryDescriptionOccupational TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseOT.006137Ohio