| NPI | 1497159446 |
|---|---|
| Former Legal Business Name | NICOLE LAROSE, LLC |
| Entity Type | Organization |
| Authorized Contact | NICOLE LAROSE Owner 843-425-7963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: SC 3326) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2021-02-24 |