Provider Demographics
NPI:1528393816
Name:REESE, NICOLE ELAINE (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELAINE
Last Name:REESE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9413 APISON PIKE STE 108
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5628
Mailing Address - Country:US
Mailing Address - Phone:423-396-2100
Mailing Address - Fax:
Practice Address - Street 1:9413 APISON PIKE SUITE 108
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363
Practice Address - Country:US
Practice Address - Phone:423-396-2100
Practice Address - Fax:423-396-2670
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLMT7751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist