Individual
THERESA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2600 COMPASS RD, GLENVIEW, IL 60026-8001
(302) 764-7268
Mailing address
317 BEVERLY PL, BELLEFONTE, DE 19809-2907
(302) 593-2132
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
U20000966
DE
Other
Enumeration date
09/24/2018
Last updated
09/24/2018
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