Individual
KELBY RENEE NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
610 N MISSOURI ST STE 1, WEST MEMPHIS, AR 72301-3148
(870) 400-0179
(870) 400-0479
Mailing address
610 N MISSOURI ST STE 1, WEST MEMPHIS, AR 72301-3148
(870) 400-0179
(870) 400-0479
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1668
AR
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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