Provider Demographics
NPI:1558596189
Name:PICKERING, MONICA (ATC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PICKERING
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 1:145 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:WI
Mailing Address - Zip Code:54659-9703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:WI
Practice Address - Zip Code:54659-9703
Practice Address - Country:US
Practice Address - Phone:630-470-8206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer