Provider Demographics
NPI:1255476412
Name:BOURG, NADINE THERESA (CERTIFIED ORTHOTIST)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:THERESA
Last Name:BOURG
Suffix:
Gender:F
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-4220
Mailing Address - Country:US
Mailing Address - Phone:404-788-3839
Mailing Address - Fax:423-697-0057
Practice Address - Street 1:3700 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3603
Practice Address - Country:US
Practice Address - Phone:423-697-0057
Practice Address - Fax:423-607-0666
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist