Healthcare Provider Details

I. General information

NPI: 1144262619
Provider Name (Legal Business Name): NICOLE K FEINAUER ATC, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE KELLEY ATC

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HAWTHORNE DR
BEDFORD NH
03110-6983
US

IV. Provider business mailing address

4 HAWTHORNE DR
BEDFORD NH
03110-6983
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-8888
  • Fax: 603-472-9090
Mailing address:
  • Phone: 603-472-8888
  • Fax: 603-472-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number722
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0147
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: