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General NPI Number Information
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NPI Number | 1245568484
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Entity Type | Individual
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Provider Name | SEAN ERIC NICHOLSON OTR/L
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Gender | Male
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 1303 CAMELOT BAY
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City | MOUNT JULIET
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State | TN
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Zip | 37122-1354
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Country | US
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Telephone | 615-804-1297
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Fax | 615-773-4789
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Provider Business Mailing Address
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Address Line | 1303 CAMELOT BAY
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City | MOUNT JULIET
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State | TN
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Zip | 37122-1354
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Country | US
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Telephone | 615-804-1297
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Fax | 615-773-4789
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT000002518
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License Number State | TN
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