Healthcare Provider Details

I. General information

NPI: 1447965322
Provider Name (Legal Business Name): MOLLY NESTLEROAD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14615 WESTBROOK CIR APT 212
BRADENTON FL
34211-2333
US

IV. Provider business mailing address

14615 WESTBROOK CIR APT 212
BRADENTON FL
34211-2333
US

V. Phone/Fax

Practice location:
  • Phone: 765-667-5468
  • Fax:
Mailing address:
  • Phone: 765-667-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17299
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-261575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: