Individual
JESSICA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
906 TETBURY PL, BRANDON, MS 39047-9274
(662) 820-8732
Mailing address
906 TETBURY PL, BRANDON, MS 39047-9274
(662) 820-8732
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1648
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07728286
—
MS
Enumeration date
10/09/2007
Last updated
08/03/2021
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