Individual
JEWEL OPAL AMETHYST NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1615 MIAMI RD, FORT LAUDERDALE, FL 33316-2933
(954) 523-5673
Mailing address
5903 LONDON LN, TAMARAC, FL 33321-4186
(646) 379-6232
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
FL
Other
Enumeration date
12/13/2017
Last updated
03/17/2018
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