Provider Demographics
NPI:1538430947
Name:URBANOWSKI, NICOLE (OT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:URBANOWSKI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4161 TAMIAMI TRL
Mailing Address - Street 2:103
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-743-6700
Mailing Address - Fax:
Practice Address - Street 1:400 TAMIAMI TRL S
Practice Address - Street 2:#210
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2614
Practice Address - Country:US
Practice Address - Phone:941-483-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15006225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation