Provider Demographics
NPI:1770800161
Name:OSWALD, NICHOLE ANN (MOT OTR)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ANN
Last Name:OSWALD
Suffix:
Gender:F
Credentials:MOT OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-1169
Mailing Address - Country:US
Mailing Address - Phone:317-353-7007
Mailing Address - Fax:
Practice Address - Street 1:501 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1169
Practice Address - Country:US
Practice Address - Phone:317-353-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004430A225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology