Provider Demographics
NPI:1841770989
Name:WINCHESTER, NICOLETTE A
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:A
Last Name:WINCHESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8108 JACK RUSSELL CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3078
Mailing Address - Country:US
Mailing Address - Phone:865-256-1707
Mailing Address - Fax:
Practice Address - Street 1:8108 JACK RUSSELL CT
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3078
Practice Address - Country:US
Practice Address - Phone:865-256-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist