Provider Demographics
NPI:1649447400
Name:NICHOLS, DAWN L (OTR)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S66W25120 MORAINE CT
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9607
Mailing Address - Country:US
Mailing Address - Phone:262-662-0571
Mailing Address - Fax:
Practice Address - Street 1:S66W25120 MORAINE CT
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-9607
Practice Address - Country:US
Practice Address - Phone:262-662-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist