Healthcare Provider Details

I. General information

NPI: 1780223826
Provider Name (Legal Business Name): JULIE NICOLE LEPAGE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SAINT ANSELM DR
MANCHESTER NH
03102-1308
US

IV. Provider business mailing address

9 LOCKELAND RD
WINCHESTER MA
01890-3341
US

V. Phone/Fax

Practice location:
  • Phone: 603-641-7807
  • Fax:
Mailing address:
  • Phone: 408-656-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3195
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1349
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: