Provider Demographics
NPI:1891225686
Name:ALBERTY, NICHOLS BRADLEY (LICENSED ORTHOTIST)
Entity Type:Individual
Prefix:
First Name:NICHOLS
Middle Name:BRADLEY
Last Name:ALBERTY
Suffix:
Gender:M
Credentials:LICENSED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 E DOWNING ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3363
Mailing Address - Country:US
Mailing Address - Phone:918-431-1945
Mailing Address - Fax:918-431-1974
Practice Address - Street 1:1294 EAST DOWNING
Practice Address - Street 2:SUITE 3
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-431-1945
Practice Address - Fax:918-431-1974
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist