Provider Demographics
NPI:1194809608
Name:NICHOLSON, BETH GARDNER (OTR, CHT)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:GARDNER
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3269 BROOK HIGHLAND TRCE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5814
Mailing Address - Country:US
Mailing Address - Phone:205-981-7167
Mailing Address - Fax:205-298-9013
Practice Address - Street 1:3234 CAHABA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-1614
Practice Address - Country:US
Practice Address - Phone:205-383-8579
Practice Address - Fax:205-298-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0133225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51005522OtherBLUE CROSS
AL51510089OtherBLUE CROSS DME PROV #
AL51510089OtherBLUE CROSS DME PROV #
AL051507975Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER