Provider Demographics
NPI:1174780522
Name:NICHOLAS, SARAH CHRISTINE (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CHRISTINE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 REED AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1160
Mailing Address - Country:US
Mailing Address - Phone:307-432-6868
Mailing Address - Fax:
Practice Address - Street 1:3920 REED AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1160
Practice Address - Country:US
Practice Address - Phone:307-432-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOTR-451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist