MEDICARE: MS. CARLA JEAN NICHOLS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT038811	TX

General Provider Information

NPI Number	:	1063744506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA JEAN NICHOLS LMT

Provider Business Mailing Address
First Line	:	5302 PEPPERBUSH
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-3480
Country	:	US
Telephone Number	:	940-867-5933
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 RHEA RD
Second Line	:	SUITE 8-A
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2739
Country	:	US
Telephone Number	:	940-692-1311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/09/2010

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