Individual
NICHOLE LYNN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5820
Mailing address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5000
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1760
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201106280A
—
OK
Enumeration date
11/17/2016
Last updated
11/21/2023
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