Provider Demographics
NPI:1750933081
Name:NICHOLS, BALEIGH ANN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:BALEIGH
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 TURNBURY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6168
Mailing Address - Country:US
Mailing Address - Phone:252-341-9944
Mailing Address - Fax:252-439-0957
Practice Address - Street 1:1925 TURNBURY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6168
Practice Address - Country:US
Practice Address - Phone:252-341-9944
Practice Address - Fax:252-439-0957
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2020-11-05
Deactivation Date:2020-10-19
Deactivation Code:
Reactivation Date:2020-11-05
Provider Licenses
StateLicense IDTaxonomies
NC12450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist