Provider Demographics
NPI:1134333420
Name:GRIERSON, NICHOLE LEE (ATC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LEE
Last Name:GRIERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:LEE
Other - Last Name:AYRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:10705 WAR ADMIRAL DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7938
Mailing Address - Country:US
Mailing Address - Phone:859-240-2961
Mailing Address - Fax:
Practice Address - Street 1:1918 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7931
Practice Address - Country:US
Practice Address - Phone:859-356-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT6262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer