MEDICARE: NIKOLE MARIE GARABRANDT

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
1	225200000X	Physical Therapy Assistant	05286	OH

General Provider Information

NPI Number	:	1174926901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOLE MARIE GARABRANDT

Provider Business Mailing Address
First Line	:	245 S BROADWAY ST
Second Line	:
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-3842
Country	:	US
Telephone Number	:	330-339-2151
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 S BROADWAY ST
Second Line	:
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-3842
Country	:	US
Telephone Number	:	330-339-2151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2014
Last Update Date	:	10/07/2014

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