Individual
MRS. CARLY ANNE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD OTR/L
Contact information
Practice address
1601 CENTRAL AVE W, WIGGINS, MS 39577-2401
(601) 716-3196
(601) 974-9919
Mailing address
1620 HIGHWAY 11 N STE C, PICAYUNE, MS 39466-2070
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-4116
MS
Other
Enumeration date
11/20/2019
Last updated
05/07/2024
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