MEDICARE: NICOLE HORNEBER OTRL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201009785	MI

General Provider Information

NPI Number	:	1679006126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HORNEBER OTRL

Provider Business Mailing Address
First Line	:	701 WILLIAMSBURG DR
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-1315
Country	:	US
Telephone Number	:	989-233-6104
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 CHAMBERS RD
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-9240
Country	:	US
Telephone Number	:	989-233-6104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	05/07/2024

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Directions to “ NICOLE HORNEBER OTRL” Practice Location

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