Provider Demographics
NPI:1851603153
Name:NICHOLSON, KAREN MARIA (OCCUPATIONAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIA
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:MARIA
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21904 112TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2538
Mailing Address - Country:US
Mailing Address - Phone:917-355-4158
Mailing Address - Fax:
Practice Address - Street 1:21904 112TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2538
Practice Address - Country:US
Practice Address - Phone:917-355-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016122-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist