Provider Demographics
NPI:1467699884
Name:WILLIAMS, NICOLE ANNE (ATC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TOWER ST
Mailing Address - Street 2:APT 3
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1930
Mailing Address - Country:US
Mailing Address - Phone:540-238-9174
Mailing Address - Fax:
Practice Address - Street 1:9 TOWER ST
Practice Address - Street 2:APT 3
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570
Practice Address - Country:US
Practice Address - Phone:540-239-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer