=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760379747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS REID OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2025
-----------------------------------------------------
Last Update Date | 06/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 962 GARLAND ST E
-----------------------------------------------------
City | WEST SALEM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54669-1308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-786-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 943 GARLAND ST E # B10
-----------------------------------------------------
City | WEST SALEM
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54669-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-525-1541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 8823-6
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------