Individual
LARRY NICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
916 NOBLE ST, ALVA, OK 73717-2852
(888) 873-4221
Mailing address
916 NOBLE ST, ALVA, OK 73717-2852
(888) 873-4221
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2517
OK
Other
Enumeration date
05/18/2015
Last updated
05/18/2015
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