Healthcare Provider Details

I. General information

NPI: 1578000337
Provider Name (Legal Business Name): NICHOLAS ROBERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 EDMONDSON PIKE SUITE 103
NASHVILLE TN
37211-5872
US

IV. Provider business mailing address

PO BOX 681478
FRANKLIN TN
37068-1478
US

V. Phone/Fax

Practice location:
  • Phone: 615-831-1710
  • Fax: 615-831-1968
Mailing address:
  • Phone: 615-591-6590
  • Fax: 615-591-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5356
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: