Provider Demographics
NPI:1609453869
Name:OGLES, NICHOLAS F (LAT, ATC, S-EMR)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:F
Last Name:OGLES
Suffix:
Gender:M
Credentials:LAT, ATC, S-EMR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:S HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1399
Mailing Address - Country:US
Mailing Address - Phone:978-564-0655
Mailing Address - Fax:978-468-3758
Practice Address - Street 1:537 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:S HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-1399
Practice Address - Country:US
Practice Address - Phone:978-564-0655
Practice Address - Fax:978-468-3758
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH-14852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer