Provider Demographics
NPI:1215092341
Name:NICHOLAS, JOANNA J (OTR)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:J
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 WESTCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-4372
Mailing Address - Country:US
Mailing Address - Phone:608-712-4089
Mailing Address - Fax:
Practice Address - Street 1:7710 S BROOKLINE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3511
Practice Address - Country:US
Practice Address - Phone:608-833-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3717-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist