Provider Demographics
NPI:1710551221
Name:DEMETROS, NICHOLAS JAMES III (OTR/L)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:DEMETROS
Suffix:III
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2056 MORTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-8100
Mailing Address - Country:US
Mailing Address - Phone:615-584-3538
Mailing Address - Fax:
Practice Address - Street 1:719 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2809
Practice Address - Country:US
Practice Address - Phone:615-714-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist