Provider Demographics
NPI:1699829903
Name:CHAMBLIESS, NICHOLE A (OT)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:A
Last Name:CHAMBLIESS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:NE
Mailing Address - Zip Code:68031-3028
Mailing Address - Country:US
Mailing Address - Phone:402-654-3371
Mailing Address - Fax:
Practice Address - Street 1:430 N. MONITOR ST.
Practice Address - Street 2:ST. FRANCIS HOSPITAL
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788
Practice Address - Country:US
Practice Address - Phone:402-372-2372
Practice Address - Fax:402-372-6773
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist