Provider Demographics
NPI:1407827603
Name:EBEL, NICHOLA DOYLE (OTR L)
Entity Type:Individual
Prefix:MS
First Name:NICHOLA
Middle Name:DOYLE
Last Name:EBEL
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:NICHOLA
Other - Middle Name:JANE
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:4 PINE CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850
Mailing Address - Country:US
Mailing Address - Phone:541-963-5684
Mailing Address - Fax:
Practice Address - Street 1:2519 COVE AVE
Practice Address - Street 2:MOUNTAIN VALLEY THERAPY
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850
Practice Address - Country:US
Practice Address - Phone:541-962-0830
Practice Address - Fax:541-975-2720
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR987672225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist