Provider Demographics
NPI:1871709485
Name:NICHOLS, EMILY ROSE (OTRL)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CHESTNUT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5241
Mailing Address - Country:US
Mailing Address - Phone:509-954-6767
Mailing Address - Fax:
Practice Address - Street 1:800 E CHESTNUT ST STE 200
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5241
Practice Address - Country:US
Practice Address - Phone:360-788-8143
Practice Address - Fax:360-752-0660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0217306OtherLABOR AND INDUSTRIES