Provider Demographics
NPI:1275880940
Name:OCHOTORENA, NICOLE KAMELANI (MOTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KAMELANI
Last Name:OCHOTORENA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 S PARKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7614
Mailing Address - Country:US
Mailing Address - Phone:813-417-8738
Mailing Address - Fax:
Practice Address - Street 1:255 59TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8539
Practice Address - Country:US
Practice Address - Phone:727-345-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist