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General NPI Number Information
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NPI Number | 1073639274
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Entity Type | Individual
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Provider Name | MICHELE ANNETTE NICHOLS C.O.T.A
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3590 WASHINGTON PIKE
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City | BRIDGEVILLE
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State | PA
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Zip | 15017-1047
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Country | US
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Telephone | 412-257-2474
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Fax |
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Provider Business Mailing Address
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Address Line | 666 MAPLE LN
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City | SEWICKLEY
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State | PA
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Zip | 15143-1913
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Country | US
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Telephone | 412-749-5439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OP003245L
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License Number State | PA
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