Provider Demographics
NPI:1578630059
Name:NICKELS, JULIE T (OTR)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:T
Last Name:NICKELS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 W HURON ST # 2
Mailing Address - Street 2:CHICAGO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1205
Mailing Address - Country:US
Mailing Address - Phone:773-562-8345
Mailing Address - Fax:
Practice Address - Street 1:2325 W HURON ST # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1205
Practice Address - Country:US
Practice Address - Phone:773-562-8345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.006142225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics