Individual
LORRAINE MARIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
415 BENEDUM DR, BRIDGEPORT, WV 26330-1503
(877) 842-9887
Mailing address
102 DONALD ST, SAINT MARYS, WV 26170-9630
(304) 483-4937
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1442
WV
Other
Enumeration date
05/28/2010
Last updated
05/28/2010
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