Provider Demographics
NPI:1831921576
Name:OSBORNE, SHIRLEY NICOLE (COTA)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:NICOLE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 32ND ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-2705
Mailing Address - Country:US
Mailing Address - Phone:941-539-4810
Mailing Address - Fax:
Practice Address - Street 1:22 SARASOTA CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9770
Practice Address - Country:US
Practice Address - Phone:941-377-9361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA19954224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant