Provider Demographics
NPI:1699198820
Name:NICHOLS, JENNIFER LINDSY I (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LINDSY
Last Name:NICHOLS
Suffix:I
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 1:2695 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506
Mailing Address - Country:US
Mailing Address - Phone:970-243-1388
Mailing Address - Fax:
Practice Address - Street 1:2695 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8814
Practice Address - Country:US
Practice Address - Phone:970-243-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0005158225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist