Provider Demographics
NPI:1265778658
Name:NELSON, MIKIELA
Entity type:Individual
Prefix:MS
First Name:MIKIELA
Middle Name:
Last Name:NELSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MIKIELA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10300 SPRING WATER LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6667
Mailing Address - Country:US
Mailing Address - Phone:301-785-1025
Mailing Address - Fax:
Practice Address - Street 1:9698 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3767
Practice Address - Country:US
Practice Address - Phone:301-785-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist