Provider Demographics
NPI:1578458006
Name:NICHOLS, NICOLE ELAINE (MA00006680)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELAINE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MA00006680
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-4940
Mailing Address - Country:US
Mailing Address - Phone:360-402-0291
Mailing Address - Fax:
Practice Address - Street 1:3901 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4940
Practice Address - Country:US
Practice Address - Phone:253-756-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist