Provider Demographics
NPI:1386857324
Name:NOLA, DARIA MARIE (MAT, ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:DARIA
Middle Name:MARIE
Last Name:NOLA
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2535
Mailing Address - Country:US
Mailing Address - Phone:203-452-1208
Mailing Address - Fax:
Practice Address - Street 1:44 LEWIS RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-2535
Practice Address - Country:US
Practice Address - Phone:203-452-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0004342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer