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NPI Code Detail

MEDICARE: MRS. MICHELE ANNETTE NICHOLS C.O.T.A

MEDICARE: MRS. MICHELE ANNETTE NICHOLS C.O.T.A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOP003245LPA

General Provider Information

NPI Number : 1073639274
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE ANNETTE NICHOLS C.O.T.A
Provider Business Mailing Address
First Line : 666 MAPLE LN
Second Line :
City : SEWICKLEY
State : PA
Zip : 15143-1913
Country : US
Telephone Number : 412-749-5439
Fax Number :
Provider Business Practice Location Address
First Line : 3590 WASHINGTON PIKE
Second Line :
City : BRIDGEVILLE
State : PA
Zip : 15017-1047
Country : US
Telephone Number : 412-257-2474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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