Provider Demographics
NPI:1750516605
Name:NICHOLAS, NANCY ELLIS (MOTR/L)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELLIS
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RANDOLPH AVE # 2
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1110
Mailing Address - Country:US
Mailing Address - Phone:802-578-3084
Mailing Address - Fax:
Practice Address - Street 1:9 HAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4832
Practice Address - Country:US
Practice Address - Phone:802-775-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist