Provider Demographics
NPI:1467515783
Name:NICHOLS, DENISE E (OT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 E STATE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2262
Mailing Address - Country:US
Mailing Address - Phone:815-637-1100
Mailing Address - Fax:815-637-1200
Practice Address - Street 1:4920 E STATE ST STE 4
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2262
Practice Address - Country:US
Practice Address - Phone:815-637-1100
Practice Address - Fax:815-637-1200
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist