Provider Demographics
NPI:1730897281
Name:NICHOLS, KOBIE (MT)
Entity type:Individual
Prefix:
First Name:KOBIE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 4TH ST NW APT 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3152
Mailing Address - Country:US
Mailing Address - Phone:424-236-0119
Mailing Address - Fax:
Practice Address - Street 1:5412 4TH ST NW APT 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3152
Practice Address - Country:US
Practice Address - Phone:424-236-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT2000081225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist