Provider Demographics
NPI:1629351523
Name:HOOVER, NICOLE ANN (OTR)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:HOOVER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BOLWERK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5000 W. NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295
Mailing Address - Country:US
Mailing Address - Phone:414-453-7418
Mailing Address - Fax:414-453-7420
Practice Address - Street 1:2500 N MAYFAIR RD
Practice Address - Street 2:SUITE 670
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1409
Practice Address - Country:US
Practice Address - Phone:414-453-7418
Practice Address - Fax:414-453-7420
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5083-026225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand