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NPI Code Detail

MEDICARE: MRS. AMBER MARIE NICHOLS MS, ATC, PES

MEDICARE: MRS. AMBER MARIE NICHOLS MS, ATC, PES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer001224-1NY

General Provider Information

NPI Number : 1124248976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMBER MARIE NICHOLS MS, ATC, PES
Provider Business Mailing Address
First Line : 65 PEPPERMINT DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14615-1242
Country : US
Telephone Number : 585-621-9105
Fax Number :
Provider Business Practice Location Address
First Line : 92 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1306
Country : US
Telephone Number : 585-750-0749
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 07/08/2007

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