Individual
DEBRA RENAE NICKOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
401 E ONTARIO ST APT 4003, CHICAGO, IL 60611-4443
(614) 668-6237
Mailing address
401 E ONTARIO ST APT 4003, CHICAGO, IL 60611-4443
(614) 668-6237
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
070018390
IL
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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