Healthcare Provider Details

I. General information

NPI: 1952894446
Provider Name (Legal Business Name): NICOLE MAISEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W PATRICK ST
FREDERICK MD
21701-4089
US

IV. Provider business mailing address

6694 GLEN LN
NEW MARKET MD
21774-6925
US

V. Phone/Fax

Practice location:
  • Phone: 301-620-1414
  • Fax:
Mailing address:
  • Phone: 240-604-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: