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NPI Code Detail

MEDICARE: MS. BETH GARDNER NICHOLSON OTR, CHT

MEDICARE: MS. BETH GARDNER NICHOLSON OTR, CHT
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
1225XH1200XHand Occupational Therapist0133AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151005522OTHERALBLUE CROSS
251510089OTHERALBLUE CROSS DME PROV #

General Provider Information

NPI Number : 1194809608
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BETH GARDNER NICHOLSON OTR, CHT
Provider Business Mailing Address
First Line : 3269 BROOK HIGHLAND TRCE
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-5814
Country : US
Telephone Number : 205-981-7167
Fax Number : 205-298-9013
Provider Business Practice Location Address
First Line : 3234 CAHABA HEIGHTS RD
Second Line :
City : VESTAVIA
State : AL
Zip : 35243-1614
Country : US
Telephone Number : 205-383-8579
Fax Number : 205-298-9103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 11/14/2011

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