Provider Demographics
NPI:1215433479
Name:NICHOLS, AMY SUSAN (MS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUSAN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W 42ND ST STE 228
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-3300
Mailing Address - Country:US
Mailing Address - Phone:317-414-7632
Mailing Address - Fax:
Practice Address - Street 1:1100 W 42ND ST STE 228
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-3300
Practice Address - Country:US
Practice Address - Phone:317-414-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist