Healthcare Provider Details

I. General information

NPI: 1609453869
Provider Name (Legal Business Name): NICHOLAS F OGLES LAT, ATC, S-EMR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 HIGHLAND ST
S HAMILTON MA
01982-1399
US

IV. Provider business mailing address

537 HIGHLAND ST
S HAMILTON MA
01982-1399
US

V. Phone/Fax

Practice location:
  • Phone: 978-564-0655
  • Fax: 978-468-3758
Mailing address:
  • Phone: 978-564-0655
  • Fax: 978-468-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAH-1485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: