Provider Demographics
NPI:1770757106
Name:HUNTER NICHOLS, KIM (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:HUNTER NICHOLS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KM
Other - Middle Name:
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:507 CHAD AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2132
Mailing Address - Country:US
Mailing Address - Phone:410-336-4587
Mailing Address - Fax:
Practice Address - Street 1:507 CHAD AVE
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2132
Practice Address - Country:US
Practice Address - Phone:410-336-4587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04199225X00000X
DC714000872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist