MEDICARE: KERRI NICHOLS

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	224Z00000X	Occupational Therapy Assistant	OP003158L	PA

General Provider Information

NPI Number	:	1699077792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI NICHOLS

Provider Business Mailing Address
First Line	:	119 JOE LICK RD
Second Line	:
City	:	SCOTT TWP
State	:	PA
Zip	:	18447-7626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 JOE LICK RD
Second Line	:
City	:	SCOTT TWP
State	:	PA
Zip	:	18447-7626
Country	:	US
Telephone Number	:	570-563-2759
Fax Number	:

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

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	11/22/2010

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Directions to “ KERRI NICHOLS ” Practice Location

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