Provider Demographics
NPI:1225240294
Name:CARNEY DANIELS, NIKOLE (ATC)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:CARNEY DANIELS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 HOOP POLE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43777-9555
Mailing Address - Country:US
Mailing Address - Phone:740-697-0889
Mailing Address - Fax:
Practice Address - Street 1:9600 HOOP POLE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43777-9555
Practice Address - Country:US
Practice Address - Phone:740-697-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer