Provider Demographics
NPI:1295392652
Name:NICHOLS, VICTORIA JUDE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JUDE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:JUDE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:2610 TORREY PINES RD APT D36
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3452
Mailing Address - Country:US
Mailing Address - Phone:949-702-3755
Mailing Address - Fax:
Practice Address - Street 1:8775 AERO DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1792
Practice Address - Country:US
Practice Address - Phone:619-578-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13897225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics