Provider Demographics
NPI:1699403832
Name:GOURLEY, NATASHA NICOLE (ATC, LAT, EMT-PM)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:ATC, LAT, EMT-PM
Other - Prefix:
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Mailing Address - Street 1:1260 COUNTY HIGHWAY J23
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50840-8814
Mailing Address - Country:US
Mailing Address - Phone:641-344-2707
Mailing Address - Fax:641-464-4474
Practice Address - Street 1:504 N CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-2201
Practice Address - Country:US
Practice Address - Phone:641-344-2707
Practice Address - Fax:641-464-4474
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA0006932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer