Provider Demographics
NPI:1255882379
Name:NICHOLS-HOLDEN, JACQUELINE M (LMT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:NICHOLS-HOLDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CROFT CT
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1233
Mailing Address - Country:US
Mailing Address - Phone:757-869-4838
Mailing Address - Fax:866-674-2685
Practice Address - Street 1:10 CROFT CT
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379
Practice Address - Country:US
Practice Address - Phone:860-333-8801
Practice Address - Fax:866-674-2685
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008879OtherSTATE OF CONNECTICUT