Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5201008761 | MI |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1275959744 |
---|---|
Provider Name | Ashley Nichols |
First Address | Kalamazoo, MI 49009-6922 |
Second Address | Paw Paw, MI 49079-8242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2014 |
Last Update Date | 11/07/2019 |