Healthcare Provider Details

I. General information

NPI: 1770546582
Provider Name (Legal Business Name): NANCY KAY BLEAM ATC-RET, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE 10 NW, ROOM 1079
BOSTON MA
02115-5724
US

IV. Provider business mailing address

219 ATLANTIC AVE UNIT 3
HULL MA
02045-3060
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7468
  • Fax:
Mailing address:
  • Phone: 603-762-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: