Provider Demographics
NPI:1972074557
Name:NICHOLES, MEGAN ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:NICHOLES
Suffix:
Gender:F
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 1:20 CARREAU AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3729
Mailing Address - Country:US
Mailing Address - Phone:516-592-1792
Mailing Address - Fax:631-752-3938
Practice Address - Street 1:116 E CARMANS RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3836
Practice Address - Country:US
Practice Address - Phone:631-752-3938
Practice Address - Fax:631-752-3938
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022635225X00000X
NJ46TR01017600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist