Provider Demographics
NPI:1043289259
Name:ADAMS, NICHOLE E (MED, ATC, LAT, OTC)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MED, ATC, LAT, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1 S KEENE ST
Mailing Address - Street 2:COLUMBIA ORTHOPEDIC GROUP
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7199
Mailing Address - Country:US
Mailing Address - Phone:573-443-2402
Mailing Address - Fax:573-441-3745
Practice Address - Street 1:1 S KEENE ST
Practice Address - Street 2:COLUMBIA ORTHOPEDIC GROUP
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7199
Practice Address - Country:US
Practice Address - Phone:573-443-2402
Practice Address - Fax:573-441-3745
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20080346362255A2300X
IL0960020772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer