Provider Demographics
NPI:1174875355
Name:PARKER, NICOLE MARIE (ATC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7460 MCCRAY RD
Mailing Address - Street 2:FAIRVIEW SCHOOL DISTRICT
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-2401
Mailing Address - Country:US
Mailing Address - Phone:814-474-3121
Mailing Address - Fax:814-474-9814
Practice Address - Street 1:7460 MCCRAY RD
Practice Address - Street 2:FAIRVIEW SCHOOL DISTRICT
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-2401
Practice Address - Country:US
Practice Address - Phone:814-474-3121
Practice Address - Fax:814-474-9814
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001680A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer