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Individual

KRISTIE NICKERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS OTR/L

Contact information

Practice address
119 OFFICE PARK DR, ORANGEBURG, SC 29118-2407
(803) 536-5509
Mailing address
34 LOON DR, TOPSHAM, ME 04086-1538
(207) 837-4447

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4040
SC
225XP0200X
Pediatric Occupational Therapist
OT 3011
ME

Other

Enumeration date
06/24/2015
Last updated
12/13/2017
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