Provider Demographics
NPI:1659960938
Name:ALLEN, NICHOLLE ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:NICHOLLE
Middle Name:ANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7137
Mailing Address - Country:US
Mailing Address - Phone:401-808-8189
Mailing Address - Fax:401-808-8169
Practice Address - Street 1:1239 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7137
Practice Address - Country:US
Practice Address - Phone:401-808-8189
Practice Address - Fax:401-808-8169
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist