MEDICARE: MRS. EMILY ANN NICHOLS OTR

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
1	225X00000X	Occupational Therapist	110761	TX

General Provider Information

NPI Number	:	1558689034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY ANN NICHOLS OTR

Provider Business Mailing Address
First Line	:	806 NEWELL AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75223-1162
Country	:	US
Telephone Number	:	469-334-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 NEWELL AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75223-1162
Country	:	US
Telephone Number	:	469-334-0025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2010
Last Update Date	:	05/09/2010

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