Provider Demographics
NPI:1780291393
Name:NICOLE BILODEAU, LLC
Entity type:Organization
Organization Name:NICOLE BILODEAU, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:813-557-5388
Mailing Address - Street 1:1814 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6224
Mailing Address - Country:US
Mailing Address - Phone:813-557-5388
Mailing Address - Fax:
Practice Address - Street 1:1814 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6224
Practice Address - Country:US
Practice Address - Phone:813-557-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICOLE BILODEAU, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty