Provider Demographics
NPI:1245568484
Name:NICHOLSON, SEAN ERIC (OTR/L)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ERIC
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 CAMELOT BAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-1354
Mailing Address - Country:US
Mailing Address - Phone:615-804-1297
Mailing Address - Fax:615-773-4789
Practice Address - Street 1:1303 CAMELOT BAY
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-1354
Practice Address - Country:US
Practice Address - Phone:615-804-1297
Practice Address - Fax:615-773-4789
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT000002518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist