Provider Demographics
NPI:1083006076
Name:NICHOLAS, JENNIFER RHODES (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RHODES
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10803 FALLS ROAD, SUITE 2100
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-583-2666
Mailing Address - Fax:410-847-3838
Practice Address - Street 1:10803 FALLS ROAD, SUITE 2100
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-583-2666
Practice Address - Fax:410-847-3838
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06208225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand