Individual
HEATHER LEE NICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
1020 S PARKWAY ST, CAPE GIRARDEAU, MO 63703-7704
(573) 290-5799
(573) 339-0196
Mailing address
20744 KIEFER LN, STE GENEVIEVE, MO 63670-8756
(636) 328-1066
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2017006776
MO
Other
Enumeration date
07/19/2018
Last updated
07/19/2018
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