MEDICARE: MRS. NICOLE MERCIER COMER

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1982860565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE MERCIER COMER

Provider Business Mailing Address
First Line	:	15 ANTHONY LN
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 ANTHONY LN
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2913
Country	:	US
Telephone Number	:	859-740-4448
Fax Number	:

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

Provider Enumeration Date	:	08/02/2008
Last Update Date	:	08/02/2008

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