Provider Demographics
NPI:1801148325
Name:LOBIANCO, NICOLE KATHLEEN (OTR/L)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHLEEN
Last Name:LOBIANCO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:3046 HUDSON WOODS CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1609
Mailing Address - Country:US
Mailing Address - Phone:404-805-7825
Mailing Address - Fax:678-376-9182
Practice Address - Street 1:3046 HUDSON WOODS CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1609
Practice Address - Country:US
Practice Address - Phone:404-805-7825
Practice Address - Fax:678-376-9182
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4708225X00000X, 225XN1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation