Provider Demographics
NPI:1316410608
Name:PEASE, NICOLE A (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:PEASE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:VARTERESIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:1 WINDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR LOCKS
Mailing Address - State:CT
Mailing Address - Zip Code:06096-1610
Mailing Address - Country:US
Mailing Address - Phone:413-896-2530
Mailing Address - Fax:
Practice Address - Street 1:588 LONGMEADOW ST
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2292
Practice Address - Country:US
Practice Address - Phone:413-565-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer