Provider Demographics
NPI:1588102156
Name:PATTERSON, NICOLE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15114 RIPPLEWIND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3050
Mailing Address - Country:US
Mailing Address - Phone:832-314-4288
Mailing Address - Fax:
Practice Address - Street 1:9180 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7454
Practice Address - Country:US
Practice Address - Phone:832-314-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TXAT71502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000027947OtherBOC/ATC
TXAT7150OtherTDLR/LAT