Provider Demographics
NPI:1295199776
Name:HIGHT, MARY NICOLE (BS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NICOLE
Last Name:HIGHT
Suffix:
Gender:F
Credentials:BS, ATC, LAT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:NICOLE
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, ATC, LAT
Mailing Address - Street 1:3225 WOODLAND PARK DR
Mailing Address - Street 2:#1471
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-7603
Mailing Address - Country:US
Mailing Address - Phone:936-446-7299
Mailing Address - Fax:
Practice Address - Street 1:3225 WOODLAND PARK DR
Practice Address - Street 2:#1471
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-7603
Practice Address - Country:US
Practice Address - Phone:936-446-7299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer