Provider Demographics
NPI:1073639274
Name:NICHOLS, MICHELE ANNETTE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANNETTE
Last Name:NICHOLS
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 1:666 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1913
Mailing Address - Country:US
Mailing Address - Phone:412-749-5439
Mailing Address - Fax:
Practice Address - Street 1:3590 WASHINGTON PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1047
Practice Address - Country:US
Practice Address - Phone:412-257-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003245L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant