Individual
MR. RYAN PATRICK NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
303 N HURSTBOURNE PKWY, SUITE 200, LOUISVILLE, KY 40222-5185
(502) 412-5847
Mailing address
340 TOPAZ ST, MITCHELL, IN 47446-6662
(812) 583-7824
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003499A
IN
Other
Enumeration date
09/27/2012
Last updated
09/27/2012
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