Individual
KIM A NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD, STE 774, PORT ORANGE, FL 32128-8311
(800) 330-7711
(866) 426-2811
Mailing address
111 OSBORNE LN, MADISONVILLE, KY 42431-9766
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A4194
KY
Other
Enumeration date
11/12/2012
Last updated
11/12/2012
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