Basic Information
| Provider Information | |||||||||
| NPI: | 1275872350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1314 OFFNERE ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456623504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407016962 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1805 27TH ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403565000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2013 | ||||||||
| LastUpdateDate: | 02/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.