Provider Demographics
NPI:1760379747
Name:REID, NICHOLAS (OTR/L)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 GARLAND ST E # B10
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-3301
Mailing Address - Country:US
Mailing Address - Phone:757-525-1541
Mailing Address - Fax:
Practice Address - Street 1:962 GARLAND ST E
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-1308
Practice Address - Country:US
Practice Address - Phone:608-786-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8823-6225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist