Provider Demographics
NPI:1093328049
Name:NICHOLS, RYLEE
Entity Type:Individual
Prefix:
First Name:RYLEE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 MIDDLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH CLARENDON
Mailing Address - State:VT
Mailing Address - Zip Code:05759-9440
Mailing Address - Country:US
Mailing Address - Phone:802-417-1286
Mailing Address - Fax:
Practice Address - Street 1:1083 MIDDLE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH CLARENDON
Practice Address - State:VT
Practice Address - Zip Code:05759-9440
Practice Address - Country:US
Practice Address - Phone:802-417-1286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT428725552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer