Provider Demographics
NPI:1043812134
Name:NICHOLAS, ANDREW (OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 CASTLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-9386
Mailing Address - Country:US
Mailing Address - Phone:240-422-7527
Mailing Address - Fax:
Practice Address - Street 1:1753 CASTLE ROCK RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-9386
Practice Address - Country:US
Practice Address - Phone:240-422-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist