Individual
MS. MARY A NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP, CMMP
Contact information
Practice address
195 - 1ST PLACE N.W., ISSAQUAH, WA 98027
(425) 736-7630
(425) 391-1174
Mailing address
P.O. BOX 911, PRESTON, WA 98050-0911
(425) 736-7630
(425) 391-1174
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA00014204
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0141608
DEPT. OF L & I
WA
Enumeration date
09/10/2009
Last updated
09/10/2009
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