Provider Demographics
NPI:1073989489
Name:CLEMENTS, NICOLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:VAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 SE BISHOP BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5517
Mailing Address - Country:US
Mailing Address - Phone:509-332-2828
Mailing Address - Fax:509-334-7474
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-332-2828
Practice Address - Fax:509-334-7474
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-5542255A2300X
WAA1605888302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer