Healthcare Provider Details

I. General information

NPI: 1487545398
Provider Name (Legal Business Name): NICHELLE HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 ALPHA DR STE E-97
HIGHLAND HTS OH
44143-2139
US

IV. Provider business mailing address

675 ALPHA DR STE E-97
HIGHLAND HTS OH
44143-2139
US

V. Phone/Fax

Practice location:
  • Phone: 216-804-9798
  • Fax:
Mailing address:
  • Phone: 216-804-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCOSA.901282
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCOSA.901282
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: