Healthcare Provider Details

I. General information

NPI: 1083006076
Provider Name (Legal Business Name): JENNIFER RHODES NICHOLAS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN RHODES OTR/L

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10803 FALLS ROAD, SUITE 2100
LUTHERVILLE MD
21093
US

IV. Provider business mailing address

10803 FALLS ROAD, SUITE 2100
LUTHERVILLE MD
21093
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-2666
  • Fax: 410-847-3838
Mailing address:
  • Phone: 410-583-2666
  • Fax: 410-847-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number06208
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number06208
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: