Provider Demographics
NPI:1750756219
Name:MAXWELL, CASEY NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NICOLE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:ATC
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 71
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-0071
Mailing Address - Country:US
Mailing Address - Phone:925-708-8763
Mailing Address - Fax:
Practice Address - Street 1:PRINCETON UNIVERSITY
Practice Address - Street 2:CALDWELL FIELDHOUSE, FACULTY RD
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-1033
Practice Address - Country:US
Practice Address - Phone:925-708-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001891002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer