Provider Demographics
NPI:1760831952
Name:HARDING, MIKAELA ROSE (ATC)
Entity Type:Individual
Prefix:MS
First Name:MIKAELA
Middle Name:ROSE
Last Name:HARDING
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 1:24 CABOT ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4315
Mailing Address - Country:US
Mailing Address - Phone:978-821-8003
Mailing Address - Fax:
Practice Address - Street 1:1 ALUMNI DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2282
Practice Address - Country:US
Practice Address - Phone:978-821-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH06022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer