Provider Demographics
NPI:1326407222
Name:NICHOLS, MARIN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6444 SILVER STAR LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-4677
Mailing Address - Country:US
Mailing Address - Phone:860-480-3004
Mailing Address - Fax:
Practice Address - Street 1:6444 SILVER STAR LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4677
Practice Address - Country:US
Practice Address - Phone:860-480-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist