Provider Demographics
NPI:1225071269
Name:YATES, NICOLE M (OTR/L,CHT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:YATES
Suffix:
Gender:F
Credentials:OTR/L,CHT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:927 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4306
Mailing Address - Country:US
Mailing Address - Phone:256-428-3000
Mailing Address - Fax:256-428-3003
Practice Address - Street 1:927 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4306
Practice Address - Country:US
Practice Address - Phone:256-428-3000
Practice Address - Fax:256-428-3003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51526441Medicare ID - Type Unspecified
ALQ36383Medicare UPIN