Provider Demographics
NPI:1922124205
Name:MIELE, NICHOLE LYNN-HINES (PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LYNN-HINES
Last Name:MIELE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 219TH ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1402
Mailing Address - Country:US
Mailing Address - Phone:410-437-5998
Mailing Address - Fax:
Practice Address - Street 1:24 TRUCK HOUSE RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2715
Practice Address - Country:US
Practice Address - Phone:410-544-4220
Practice Address - Fax:410-647-9484
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2670225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant