Provider Demographics
NPI:1205995982
Name:NICHOLS, RYAN ERIC (LPED)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ERIC
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8737 UNION CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4878
Mailing Address - Country:US
Mailing Address - Phone:513-733-8894
Mailing Address - Fax:513-733-8588
Practice Address - Street 1:8737 UNION CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4878
Practice Address - Country:US
Practice Address - Phone:513-733-8894
Practice Address - Fax:513-733-8588
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPED.0069222Z00000X, 224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225920002Medicare NSC