Provider Demographics
NPI:1700050614
Name:KREMER, NICOLE L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:KREMER
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:PO BOX 276
Mailing Address - Street 2:5308 SECOND AVE.
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-0276
Mailing Address - Country:US
Mailing Address - Phone:715-884-2333
Mailing Address - Fax:715-884-2333
Practice Address - Street 1:5308 2ND AVE.
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-0276
Practice Address - Country:US
Practice Address - Phone:715-884-2333
Practice Address - Fax:715-884-2333
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI246-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40297300Medicaid