Provider Demographics
NPI:1548656366
Name:ROOST, NICHOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:ROOST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 COPPER RIDGE DR STE 204D
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-6721
Mailing Address - Country:US
Mailing Address - Phone:231-300-8411
Mailing Address - Fax:
Practice Address - Street 1:4110 COPPER RIDGE DR STE 204D
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-6721
Practice Address - Country:US
Practice Address - Phone:231-300-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011112225XH1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand