Provider Demographics
NPI:1780226027
Name:ANTOMARCHY, NICOLE ARLENE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ARLENE
Last Name:ANTOMARCHY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4307
Mailing Address - Country:US
Mailing Address - Phone:786-294-5904
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5921
Practice Address - Country:US
Practice Address - Phone:786-294-5904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20392225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics