Provider Demographics
NPI:1245449073
Name:HICKEY, NADINE R (PTA)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:R
Last Name:HICKEY
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 1:419 BELLEAU BLVD.
Mailing Address - Street 2:
Mailing Address - City:EAST WAKEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03830
Mailing Address - Country:US
Mailing Address - Phone:603-941-0951
Mailing Address - Fax:603-941-0951
Practice Address - Street 1:10 COUNTY FARM RD.
Practice Address - Street 2:
Practice Address - City:CENTER OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03814
Practice Address - Country:US
Practice Address - Phone:603-539-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0520225200000X
MA3433225200000X
MEPA2822225200000X
FLPTA20746225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant