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General NPI Number Information
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NPI Number | 1205094596
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Entity Type | Individual
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Provider Name | NICOLE MARIE STABLUM OTR-L
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Gender | Female
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 6551 PARK OF COMMERCE BLVD
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City | BOCA RATON
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State | FL
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Zip | 33487-8218
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Country | US
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Telephone | 800-906-0514
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Fax |
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Provider Business Mailing Address
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Address Line | 25 SECOND AVE WEST WEST TERRACE
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City | POTTSVILLE
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State | PA
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Zip | 17901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OC007446L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT 7161
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License Number State | CA
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