Provider Demographics
NPI:1447965322
Name:NESTLEROAD, MOLLY (MT-BC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:NESTLEROAD
Suffix:
Gender:
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14615 WESTBROOK CIR APT 212
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2333
Mailing Address - Country:US
Mailing Address - Phone:765-667-5468
Mailing Address - Fax:
Practice Address - Street 1:14615 WESTBROOK CIR APT 212
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-2333
Practice Address - Country:US
Practice Address - Phone:765-667-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17299225A00000X
FLRBT-23-261575106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician