Provider Demographics
NPI:1487344362
Name:HOLBROOK, NICOLE DENISE (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DENISE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292
Mailing Address - Country:US
Mailing Address - Phone:941-485-1505
Mailing Address - Fax:
Practice Address - Street 1:3030 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292
Practice Address - Country:US
Practice Address - Phone:941-485-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16546225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand