Provider Demographics
NPI:1144671108
Name:NICHOLS, DYANA
Entity type:Individual
Prefix:
First Name:DYANA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 WELD RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-5703
Mailing Address - Country:US
Mailing Address - Phone:207-899-6095
Mailing Address - Fax:
Practice Address - Street 1:107 GIBBS MILL RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:ME
Practice Address - Zip Code:04253-3067
Practice Address - Country:US
Practice Address - Phone:207-897-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2441225XP0200X
MEOT3683225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics