Provider Demographics
NPI:1538881552
Name:NICHOLS, RACHAEL (COTA/L)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WOODLAWN TRCE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-4104
Mailing Address - Country:US
Mailing Address - Phone:901-244-9818
Mailing Address - Fax:
Practice Address - Street 1:1396 WHITING ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6839
Practice Address - Country:US
Practice Address - Phone:901-237-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3721224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant