Provider Demographics
NPI:1578809539
Name:LABONTE, NICOLE MICHELE (OTR/L)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELE
Last Name:LABONTE
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 1:11 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3715
Mailing Address - Country:US
Mailing Address - Phone:860-810-6645
Mailing Address - Fax:
Practice Address - Street 1:11 SUNSET RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3715
Practice Address - Country:US
Practice Address - Phone:860-810-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist