Provider Demographics
NPI:1528115276
Name:DEMARS, NICOLE LUCILLE (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LUCILLE
Last Name:DEMARS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LUCILLE
Other - Last Name:GINGLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:999 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3112
Mailing Address - Country:US
Mailing Address - Phone:541-687-9314
Mailing Address - Fax:541-485-6995
Practice Address - Street 1:999 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3112
Practice Address - Country:US
Practice Address - Phone:541-687-9314
Practice Address - Fax:541-485-6995
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130890Medicare ID - Type Unspecified
ORF86071Medicare UPIN