Individual
NICHOLE RAE DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
154 PEARL ST, UP STAIRS, BATAVIA, NY 14020-2914
(585) 813-6993
Mailing address
86 MYRTLE ST, LE ROY, NY 14482-1331
(585) 813-6993
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
021525
NY
Other
Enumeration date
09/18/2010
Last updated
12/28/2010
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