Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 0133 | AL |
NPI | 1194809608 |
---|---|
Provider Name | Ms. Beth Gardner Nicholson |
First Address | Birmingham, AL 35242-5814 |
Second Address | Vestavia, AL 35243-1614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51005522 | BLUE CROSS (01) | AL |
51510089 | BLUE CROSS DME PROV # (01) | AL |