Provider Demographics
NPI:1023338779
Name:NICHOLS, CATHRYN JEAN (LPN, LMT)
Entity type:Individual
Prefix:MS
First Name:CATHRYN
Middle Name:JEAN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1924
Mailing Address - Country:US
Mailing Address - Phone:304-927-0063
Mailing Address - Fax:
Practice Address - Street 1:819 CAPITOL ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1924
Practice Address - Country:US
Practice Address - Phone:304-927-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2002-1100173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV$$$$$$$$$OtherLICENCED MASSAGE THERAPIST