Individual
JEANNISE MARIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2021 E VILLAGE GREEN CIR STE C, DRAPER, UT 84020-5500
(801) 440-5592
Mailing address
2021 E VILLAGE GREEN CIR STE C, DRAPER, UT 84020-5500
(801) 440-5592
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
24261
CA
Other
Enumeration date
07/28/2023
Last updated
07/28/2023
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