Provider Demographics
NPI:1285076307
Name:NICHOLS, SARAH VITALE (OT)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:VITALE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 SUSIE B LAW RD
Mailing Address - Street 2:
Mailing Address - City:HOLLANDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38748-9710
Mailing Address - Country:US
Mailing Address - Phone:601-850-7634
Mailing Address - Fax:360-368-6227
Practice Address - Street 1:216 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1916
Practice Address - Country:US
Practice Address - Phone:870-265-3950
Practice Address - Fax:870-265-2525
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist