Provider Demographics
NPI:1952147613
Name:NICHOLS, HAYDEN L (OTR/L)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:L
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:RIVER
Other - Middle Name:L
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:417 INDIANMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-5910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:417 INDIANMEADOW DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5910
Practice Address - Country:US
Practice Address - Phone:832-225-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist