Provider Demographics
NPI:1134389521
Name:NICKELL, TONI MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:MARIE
Last Name:NICKELL
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 1:19830 SUMPTER STAGE HWY
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-7759
Mailing Address - Country:US
Mailing Address - Phone:541-523-2935
Mailing Address - Fax:
Practice Address - Street 1:19830 SUMPTER STAGE HWY
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-7759
Practice Address - Country:US
Practice Address - Phone:541-523-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR450825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist