Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4708 | GA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 4708 | GA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4708 | GA |
NPI | 1801148325 |
---|---|
Provider Name | Nicole Kathleen Lobianco |
First Address | Decatur, GA 30033-1609 |
Second Address | Decatur, GA 30033-1609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2012 |
Last Update Date | 27/05/2014 |