Healthcare Provider Details

I. General information

NPI: 1750933081
Provider Name (Legal Business Name): BALEIGH ANN NICHOLS MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date: 10/19/2020
Reactivation Date: 11/05/2020

III. Provider practice location address

1925 TURNBURY DR
GREENVILLE NC
27858-6168
US

IV. Provider business mailing address

1925 TURNBURY DR
GREENVILLE NC
27858-6168
US

V. Phone/Fax

Practice location:
  • Phone: 252-341-9944
  • Fax: 252-439-0957
Mailing address:
  • Phone: 252-341-9944
  • Fax: 252-439-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12450
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: