Provider Demographics
NPI:1386874824
Name:ROXANE M. NICHOLS, MSIS, OTR, PLLC
Entity type:Organization
Organization Name:ROXANE M. NICHOLS, MSIS, OTR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:512-858-9000
Mailing Address - Street 1:800 W HIGHWAY 290 BLDG B
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4191
Mailing Address - Country:US
Mailing Address - Phone:512-858-9000
Mailing Address - Fax:512-858-9001
Practice Address - Street 1:800 W HIGHWAY 290 BLDG B
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4191
Practice Address - Country:US
Practice Address - Phone:512-858-9000
Practice Address - Fax:512-858-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100743261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation