Basic Information
| Provider Information | |||||||||
| NPI: | 1114044732 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICOLARD | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7780 ARTHUR AVE NW | ||||||||
| Address2: | |||||||||
| City: | CANAL FULTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446149490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308541715 | ||||||||
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| Practice Location | |||||||||
| Address1: | 435 AVIS AVE NW | ||||||||
| Address2: | |||||||||
| City: | MASSILLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446463555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308371741 | ||||||||
| FaxNumber: | 3308374618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA 933 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.