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General NPI Number Information
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NPI Number | 1760831952
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Entity Type | Individual
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Provider Name | MIKAELA ROSE HARDING ATC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 1 ALUMNI DR
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City | HAMPTON
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State | NH
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Zip | 03842-2282
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Country | US
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Telephone | 978-821-8003
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Fax |
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Provider Business Mailing Address
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Address Line | 24 CABOT ST
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4315
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Country | US
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Telephone | 978-821-8003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0602
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License Number State | NH
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