MEDICARE: BETH G. NICHOLSON

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	225XH1200X	Hand Occupational Therapist	0133	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	051507975	OTHER	AL	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51005522	OTHER	AL	BLUE CROSS
3	51005521	OTHER	AL	BLUE CROSS
4	51510089	OTHER	AL	BLUE CROSS DME

General Provider Information

NPI Number	:	1568546984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETH G. NICHOLSON

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	:	205-298-9103

Provider Business Practice Location Address
First Line	:	3140 CAHABA HEIGHTS RD
Second Line	:	SUITE 102
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-5243
Country	:	US
Telephone Number	:	205-383-8579
Fax Number	:	205-298-9103

Authorized Official
Title or Position	:	OWNER
Name	:	MS. BETH GARDNER NICHOLSON
Credential	:	OTR, CHT
Telephone Number	:	205-981-7167

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	06/22/2008

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Directions to “BETH G. NICHOLSON ” Practice Location

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