Individual
PROF. THERA NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3775 WOLF LAKE RD, GRASS LAKE, MI 49240-9490
(517) 522-5013
(517) 522-5359
Mailing address
3775 WOLF LAKE RD, GRASS LAKE, MI 49240-9490
(517) 522-5013
(517) 522-5359
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
380418074
MI
Other
Enumeration date
05/01/2025
Last updated
05/01/2025
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