Provider Demographics
NPI:1134247752
Name:MARTIN, NICHOLAS (ATC, MS, LAT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:ATC, MS, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 STONECREST HTS
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-4853
Mailing Address - Country:US
Mailing Address - Phone:828-246-0438
Mailing Address - Fax:
Practice Address - Street 1:G 09 MOORE HALL
Practice Address - Street 2:WESTERN CAROLINA UNIVERSITY
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723
Practice Address - Country:US
Practice Address - Phone:828-227-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer