Provider Demographics
NPI:1417441445
Name:KEMPER, NICOLE R (LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:R
Last Name:KEMPER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CORBETT BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5361
Mailing Address - Country:US
Mailing Address - Phone:908-455-0161
Mailing Address - Fax:
Practice Address - Street 1:3304 43RD ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-6226
Practice Address - Country:US
Practice Address - Phone:908-455-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer