Provider Demographics
NPI:1316253743
Name:ADAMSON, NICHOLE ANN (MPH, OTR/L)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ANN
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:MPH, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8992 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1616
Mailing Address - Country:US
Mailing Address - Phone:703-624-8835
Mailing Address - Fax:
Practice Address - Street 1:180 MARTIN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005813225X00000X
VA0119004426225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist