Provider Demographics
NPI:1518970250
Name:NICHOLS, JANA RENEE (OTR /L)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:RENEE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OTR /L
Other - Prefix:MS
Other - First Name:JANA
Other - Middle Name:B
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR /L
Mailing Address - Street 1:11327 GIBB WHITMIRE RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-8107
Mailing Address - Country:US
Mailing Address - Phone:479-422-2876
Mailing Address - Fax:479-846-5347
Practice Address - Street 1:11327 GIBB WHITMIRE RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-8107
Practice Address - Country:US
Practice Address - Phone:479-422-2876
Practice Address - Fax:479-846-5347
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130801721Medicaid
AR5T561OtherBCBS