Provider Demographics
NPI:1922542638
Name:WELCH, NICOLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1700 SOUTH HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605
Mailing Address - Country:US
Mailing Address - Phone:417-678-2165
Mailing Address - Fax:
Practice Address - Street 1:1425 S LANDRUM ST
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712
Practice Address - Country:US
Practice Address - Phone:417-466-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014032104225X00000X
MO201403204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist