Provider Demographics
NPI:1497867980
Name:NICHOLES, PATRICIA ANN (OTR/CHT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:NICHOLES
Suffix:
Gender:F
Credentials:OTR/CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 WESTBURY AVE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1654
Mailing Address - Country:US
Mailing Address - Phone:516-333-1481
Mailing Address - Fax:
Practice Address - Street 1:346 WESTBURY AVE
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1654
Practice Address - Country:US
Practice Address - Phone:516-333-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003719-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0453920001OtherNHIC PROVIDER ID
NYQTW171Medicare PIN
NY0453920001OtherNHIC PROVIDER ID
NYA400002626Medicare PIN
NYA400002629Medicare PIN
QTW171Medicare ID - Type Unspecified
5427140001Medicare NSC