Individual
MRS. SANDRA ANN NICKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7733 FORSYTH BLVD, SAINT LOUIS, MO 63105-1817
(866) 314-3944
Mailing address
1827 HIGHWAY B, ELSBERRY, MO 63343-3126
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2002015956
MO
Other
Enumeration date
07/12/2007
Last updated
07/12/2007
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