Provider Demographics
NPI:1467646695
Name:JONES, NICHOLE L (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:204 S ERIC AVE
Mailing Address - Street 2:
Mailing Address - City:CROOKS
Mailing Address - State:SD
Mailing Address - Zip Code:57020-2088
Mailing Address - Country:US
Mailing Address - Phone:605-553-3143
Mailing Address - Fax:
Practice Address - Street 1:204 S ERIC AVE
Practice Address - Street 2:
Practice Address - City:CROOKS
Practice Address - State:SD
Practice Address - Zip Code:57020-2088
Practice Address - Country:US
Practice Address - Phone:605-553-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD187A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant