Provider Demographics
NPI:1407542947
Name:WINTER, NICOLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SCHLICKENMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:240 BEISER BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-8208
Mailing Address - Country:US
Mailing Address - Phone:302-734-7246
Mailing Address - Fax:
Practice Address - Street 1:240 BEISER BLVD STE 201
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-8208
Practice Address - Country:US
Practice Address - Phone:302-734-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00108892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer