Provider Demographics
NPI:1659563153
Name:NICHOLS, SHARON (CTRS/L)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CTRS/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 WHITE CEDAR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-6527
Mailing Address - Country:US
Mailing Address - Phone:603-433-0823
Mailing Address - Fax:
Practice Address - Street 1:903 WHITE CEDAR BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6527
Practice Address - Country:US
Practice Address - Phone:603-433-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0001OtherSTATE OF NH
NY10275OtherNATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION