Provider Demographics
NPI:1982845335
Name:NICHOLSON, NANCY (OT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6276 PATTSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368
Mailing Address - Country:US
Mailing Address - Phone:937-408-2829
Mailing Address - Fax:937-284-8186
Practice Address - Street 1:6276 LONDON PLATTSBURG RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-8801
Practice Address - Country:US
Practice Address - Phone:937-408-2829
Practice Address - Fax:937-284-8186
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5136225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics