Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00004179 | WA |
N | 225XF0002X | Feeding, Eating & Swallowing | OT00004179 | WA |
N | 225XL0004X | Low Vision | OT00004179 | WA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT00004179 | WA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT00004179 | WA |
NPI | 1154501567 |
---|---|
Provider Name | Mrs. Nicole Marie Lyman |
First Address | Wenatchee, WA 98801-1614 |
Second Address | Chelan, WA 98816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 06/11/2012 |