Provider Demographics
NPI:1225897606
Name:WOODS, NIKKI (MPS , LP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:MPS , LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-2543
Mailing Address - Country:US
Mailing Address - Phone:305-467-8923
Mailing Address - Fax:
Practice Address - Street 1:117 DOBBIN ST STE 204A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2803
Practice Address - Country:US
Practice Address - Phone:929-552-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist