Individual
STACY NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1 GEORGIAN GARDENS DR, POTOSI, MO 63664-1436
(573) 438-6261
Mailing address
7849 SAFFEL RD, BONNE TERRE, MO 63628-3415
(573) 701-5529
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2000160797
MO
Other
Enumeration date
03/11/2017
Last updated
03/11/2017
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