Provider Demographics
NPI:1265188452
Name:DAILEY, NICKLAUS SIMS (COTA/L)
Entity type:Individual
Prefix:MR
First Name:NICKLAUS
Middle Name:SIMS
Last Name:DAILEY
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S BLAIR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4410
Mailing Address - Country:US
Mailing Address - Phone:479-259-2339
Mailing Address - Fax:
Practice Address - Street 1:105 S BLAIR ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4410
Practice Address - Country:US
Practice Address - Phone:479-259-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1701224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant