Provider Demographics
NPI:1104004373
Name:NICHOLS, BETH ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6926 FIELDSTONE FARMS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8094
Mailing Address - Country:US
Mailing Address - Phone:636-300-9411
Mailing Address - Fax:
Practice Address - Street 1:324 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-5350
Practice Address - Country:US
Practice Address - Phone:636-928-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist