Carly Anne Nichols, OTD OTR/L
Individual provider Active NPI Occupational Therapist · Wiggins, MS
NPI 1679119036 · NPPES record last updated May 7, 2024
Key facts
- NPI
- 1679119036
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT-4116 (MS)
- Practice address
- 1601 Central Ave W
Wiggins, MS 39577-2401 - Phone
- (601) 716-3196
- Fax
- (601) 974-9919
- NPI assigned
- Nov 20, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT-4116 | MS | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Drayer Physical Therapy Mississippi LLC | Occupational Therapist | Current |
Accepting new patients |
| Benchmark Physical Therapy of Mississippi LLC | Occupational Therapist | Current |
Accepting new patients |
| Agilitas USA Inc | Occupational Therapist | Current |
Accepting new patients |
| Agilitas USA, Inc | Occupational Therapist | Current |
Accepting new patients |
| Drayer Physical Therapy Mississippi LLC | Past | Accepting new patients |
Locations
1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568
117 Bo Bo Dr
Crystal Springs, MS 39059
Phone (601) 892-6330
4010 Bienville Blvd
Unit E
Ocean Springs, MS 39564
Phone (228) 300-6001
3451 Goodman Rd E
Ste 108
Southaven, MS 38672
Phone (662) 253-9060
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT-4116 | MS | Yes |
Addresses
Primary practice location
1601 Central Ave W
Wiggins, MS 39577-2401
Mailing address
1620 Highway 11 N Ste C
Picayune, MS 39466-2070
Other practice location 1
1620 Highway 11 N Ste C
Picayune, MS 39466-2070
Phone (769) 242-2626
Other providers in Wiggins, MS
- Tina Miles
- Mississippi State Department of Health
- Autrionne D Monroe
- Lycel Parmosa Nall
- Brooke Naramore
- Amber Williamson Norris
- Dillon Ott
- Erica R Palmer
- Leslie Parker
- Rebekah Parker
All providers in Wiggins, MS · Occupational Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.