MEDICARE: MS. SHARON NICHOLS CTRS/L

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001	OTHER	NH	STATE OF NH
2	10275	OTHER	NY	NATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION

General Provider Information

NPI Number	:	1659563153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON NICHOLS CTRS/L

Provider Business Mailing Address
First Line	:	903 WHITE CEDAR BLVD
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-6527
Country	:	US
Telephone Number	:	603-433-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 WHITE CEDAR BLVD
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-6527
Country	:	US
Telephone Number	:	603-433-0823
Fax Number	:

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

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	03/22/2012

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