Individual
HERMINE CARRELL NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5820
(580) 379-5829
Mailing address
21325 E COUNTY ROAD 161, HEADRICK, OK 73549-9320
(580) 738-5728
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
243
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201106570A
—
OK
Enumeration date
05/08/2007
Last updated
11/21/2023
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