Individual
NICOLE LAROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSR, OTR/L
Contact information
Practice address
85 VINCENT DR # C, MT PLEASANT, SC 29464-4066
(843) 509-2642
Mailing address
976 HOUSTON NORTHCUTT BLVD, SUITE C-218, MT PLEASANT, SC 29464-3488
(843) 509-2642
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3326
SC
Other
Enumeration date
12/26/2012
Last updated
11/15/2014
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