Provider Demographics
NPI:1730465246
Name:CHAMBERLAIN, MICHELLE NICOLE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NICOLE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLANND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-0609
Mailing Address - Country:US
Mailing Address - Phone:717-368-0823
Mailing Address - Fax:
Practice Address - Street 1:669 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1409
Practice Address - Country:US
Practice Address - Phone:717-354-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL31252255A2300X
PART0052132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer