Provider Demographics
NPI:1083151807
Name:EBBIGHAUSEN, NICOLE ANN (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ANN
Last Name:EBBIGHAUSEN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:NH
Mailing Address - Zip Code:03451-2388
Mailing Address - Country:US
Mailing Address - Phone:603-336-5984
Mailing Address - Fax:
Practice Address - Street 1:49 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:NH
Practice Address - Zip Code:03451-2388
Practice Address - Country:US
Practice Address - Phone:603-336-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer