Provider Demographics
NPI:1962621607
Name:NICHOLS, ROXANE (OTR)
Entity type:Individual
Prefix:
First Name:ROXANE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist